Factors associated with short and mid-term compliance to continuous positive airway pressure in obstructive sleep apnea

Abstract

Objectives: Compliance with continuous positive airway pressure (CPAP) therapy determines the outcome of the management of obstructive sleep apnea (OSA) syndrome. The aim of the study was to examine a large panel of variables measured before CPAP therapy in OSA patients, in an attempt to identify factors associated with CPAP compliance. Material and Methods: In this retrospective cohort study, socio-demographic, psychometric, clinical, and polysomnographic (diagnostic and CPAP titration nights) variables were collected in moderate to severe OSA patients who started on CPAP therapy at home. Compliance was assessed at the 4 th and 16 th months of follow-up. Logistic regression was used to identify factors associated with poor compliance, according to different thresholds (4 h and 4 h + 70% of nights use, 5 h and 6 h). Results: After 4 months, patients ( n = 261) used their machine a median (25 th –75 th percentiles) of 85% (57–97) of days, while the median daily effective use was 4.4 (2.6–6.2) h. Factors associated with poor compliance were non-Caucasian ethnicity (all thresholds), no improvement in slow wave sleep (SWS) percentage during CPAP titration (compliance thresholds of 4 h and 4 h + 70% of nights’ use), and subjective poor quality of sleep (compliance thresholds of 5 h and 6 h). Conclusion: CPAP compliance is associated to some extent with the baseline features. Non-Caucasian patients and patients with a lack of improvement in SWS at titration or with poor sleep quality are at risk of poor compliance and could benefit from an intensive follow-up aiming to enhance compliance.