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Factors predicting CPAP adherence in obstructive sleep apnea syndrome

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) is associated with a range of neurocognitive and cardiovascular complications, leading to a compromised quality of life. Continuous positive airway pressure (CPAP) is the gold standard therapeutic intervention for this disorder, yet patient compliance remains essential to its success. This study aimed at identifying the determinants of short-term and long-term CPAP adherence in a group of Lebanese patients.

Methods

This cross-sectional study, conducted at the Sleep Center of Hôtel-Dieu de France hospital in Lebanon, included patients diagnosed with OSA and treated with CPAP for at least one night between June 2008 and January 2015. Adherence was assessed based on patients’ self-report.

Results

The study enrolled 138 patients. Adherence rate was 70.3 % at 6 months and around 50 % after 5 years. Cox models showed that use of nasal masks (HR 0.48, p = 0.048) and higher oxygen desaturation index at baseline (HR 0.98 p = 0.048) were associated with a better short-term CPAP adherence. Patients who bought their devices (HR 0.18, p < 0.001), those who were frequently contacted by the CPAP provider (HR 0.85, p 0.024), and those who reported improvement on treatment (HR 0.36, p < 0.001) were significantly more likely to remain adherent on the long term. Conversely, individuals on a diet plan tended to interrupt the treatment earlier (HR 4.85, p 0.039).

Conclusion

The present findings should be further explored in order to tailor interventions to the specific needs of different patient profiles and secure an improved CPAP adherence.

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Acknowledgments

The authors wish to thank Miss Fadia Ghedban, Mr. Ramzi Habre, and Mr. Said Sarrouf for their participation in collecting the data.

Author information

Authors and Affiliations

  1. Pulmonary and Critical Care Department, Hôtel-Dieu de France Hospital, Beirut, Lebanon

    Moussa Riachy, Samer Najem, Mirella Iskandar, Jad Choucair & Ihab Ibrahim

  2. Pulmonary and Critical Care Department, Saint Georges Hospital, Beirut, Lebanon

    Georges Juvelikian

Authors
  1. Moussa Riachy
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  2. Samer Najem
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  3. Mirella Iskandar
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  4. Jad Choucair
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  5. Ihab Ibrahim
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  6. Georges Juvelikian
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Corresponding author

Correspondence to Moussa Riachy.

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Funding

No disclosure.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the Ethics committee of the participating hospital and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Comment

This article is a retrospective single-center cohort study looking at the compliance of CPAP for OSA over 8 years. This study is unique in the patient population which is Lebanese.

The purchase of the CPAP device by the user, use of nasal mask, and frequent visits to their provider were associated with increased compliance.

Compliance continues to be a significant issue in the field of sleep medicine. Patients most in need of treatment (i.e., those with significant co-morbidities such as hypertension, coronary artery disease, and diabetes mellitus) are often least likely to utilize the therapy. As insurance has covered the device in many geographies, it is interesting that patients paying for their own equipment were more likely to be compliant. This argues that there is a need for increased education of our patients as to the importance of treatment with or without insurance coverage. It is encouraging that the newer devices and masks appear to improve compliance in this cohort.

Robin Germany

Minnesota, USA

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Riachy, M., Najem, S., Iskandar, M. et al. Factors predicting CPAP adherence in obstructive sleep apnea syndrome. Sleep Breath 21, 295–302 (2017). https://doi.org/10.1007/s11325-016-1408-y

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  • DOI: https://doi.org/10.1007/s11325-016-1408-y

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