Patient Adherence to Positive Airway Pressure Devices Used in the Treatment of Obstructive Sleep Apnea: Contributing Factors at Sleep Centers

Abstract

Background:

Chronic sleep disorders affect approximately 29.4 million American adults and 1.6 million children. Adherence to the prescribed positive airway pressure therapy (PAP), or greater than 4 hours of nightly use for at least 70% of nights for 30 consecutive days during the first 3 months of usage, is important but often problematic. We investigated factors contributing to PAP adherence to identify those which would negatively impact PAP adherence.

Methods:

A random sample of subjects greater than 18 years of age diagnosed with obstructive sleep apnea (OSA) at a single institution in an urban setting was obtained. Patients diagnosed with OSA who received an initial titration study, home PAP equipment, and follow-up consultation were included in the study. Demographic information, Charleston comorbidity index (CCI), and occurrence of prior PAP failure were collected through a retrospective review of the electronic health record. Descriptive statistics reported demographics. Binary logistic regression examined the impact of demographic factors, and CCI, on PAP compliance (P < .05, significant).

Results:

139 subjects were included. Subjects ranged from 18-84 years in age (mean 59.3 ± SD 13.2) and had a mean BMI of 37.2 (± SD 13.2). A majority (56%) were male, Caucasian (88%), and employed (50%), Table 1. The model for age, race, gender, and insurance did not significantly affect PAP adherence, χ² (7) = 13.45, P = .062. The CCI did not impact PAP adherence, χ² (1) = 0.97, P = .325. Prior PAP failure had a significant negative impact on current PAP compliance χ² (1) = 17.93, P < .001.

Conclusions:

Patients with effective PAP treatment require close follow up to ensure adherence to therapy. Prior PAP failure significantly impacts PAP adherence. To maximize the therapeutic effectiveness respiratory therapists must continue to identify and mitigate the factors that contribute to a PAP failure.

Summary of subject demographics, therapeutic outcomes and PAP adherence