Claustrophobic tendencies and continuous positive airway pressure therapy non-adherence in adults with obstructive sleep apnea

Abstract

Objectives (1) Determine frequency of claustrophobia in adults with obstructive sleep apnea (OSA) after first CPAP night; and (2) determine if claustrophobia influences CPAP adherence. Background Claustrophobia is a common clinical problem among CPAP-treated OSA adults yet few studies have examined the problem. Methods Secondary analysis of data from prospective, longitudinal study of adults with OSA (n=97). CPAP-Adapted Fear and Avoidance Scale (CPAP-FAAS) collected immediately after CPAP titration polysomnogram. The primary outcome was objective CPAP use at 1 week and 1month. Results Sixty-three percent had claustrophobic tendencies. Females had higher CPAP-FAAS scores than males. FAAS ≥25, which is a positive score for claustrophobic tendencies, was significantly influential on CPAP non-adherence at 1 week (aOR= 5.53, 95% CI 1.04, 29.24, p=0.04) and less CPAP use at 1month (aOR= 5.06, 95% CI 1.48, 17.37, p=0.01) when adjusted for body mass index and CPAP mask style. Conclusion Claustrophobia is prevalent among CPAP-treated OSA adults and influences both short-term and longer-term CPAP non-adherence. Interventions are needed to address this treatment-related barrier.

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“…However, despite the success potential of CPAP, non-adherence by patients remains a major problem [9]. Some publications have been critical regarding surgeries and their results [10]. Elshaug et al (2007) [10] proposed that for surgical treatments with success rates based on the AHI, the results should be between 5 and 10.…”

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“…Many patients dislike the machine due to its loud noise and lack of comfort. Additionally, claustrophobia and anxiety are prevalent among adults who use CPAP machines (9). Some patients opt to undergo surgery to treat OSA, however, the safety and efficacy of these surgeries are unpredictable compared to CPAP (10).…”

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“…Individuals using CPAP for <2 h were twice as likely to have higher scores on the fear and avoidance scale used to assess claustrophobia [35]. Edmonds and colleagues [36] identified 63 % of OSA sufferers had some degree of claustrophobia after their CPAP titration study, affecting females more than males and negatively impacting on adherence rates at 1 week and 1 month. One of the ongoing issues with CPAP adherence is how day-to-day difficulties and physical symptoms are treated, with an assumption they are addressed in standard clinical care.…”