Factors limiting adherence to continuous positive airway pressure treatment in patients with obstructive sleep apnoea

Alex S. W. Lowe, Masooma Shaukat, Rhiann O’Shaughnessy, Terence C. O’Shaughnessy, Vladimir M. Macavei


Background: Adherence with continuous positive airway pressure (CPAP) in patients with obstructive sleep apnoea (OSA) is a major limitation of treatment that is related to a number of individual patient characteristics. The aim of this study was to further investigate the personal aspects of reduced adherence to facilitate a more personalised approach to patients on CPAP.
Methods: We conducted a retrospective analysis of 120 patients diagnosed with OSA who were advised to commence CPAP between 1st May 2013 and 31st July 2014. OSA was defined as a dip rate 10 events/hour associated with an oxygen desaturation of 4% below baseline. Adherence was defined as CPAP use 4 hours/night for at least 70% of nights based on the CPAP adherence report or patient statement.
Results: Of the 120 patients three were excluded because of recent CPAP commencement with no available adherence information. From the remaining 117 patients, 74 (63%) were male, average age was 56 years [standard deviation (SD) 13.8], and average dip rate was 33.1 events/hour (SD 26.1). Ninety (77%) patients were on CPAP and 31 of those (34% of CPAP users) were adherent. Twenty-six patients (44% of CPAP users) with reduced adherence stated a reason such as mask difficulties (50%), a medical illness (19%), cognitive impairment (8%), shift work (8%), and being away from home (8%). There was no significant relationship between CPAP adherence and OSA severity. Twenty-seven (23%) patients were not on CPAP and in 13 reasons identified included mask difficulties (38%), referral to another hospital (23%), awaiting an Ear-Nose-Throat (ENT) opinion (15%), a medical illness (15%), and preference for a mandibular advancement device (8%).
Conclusions: This study identified a number of patient factors that contributed to reduced CPAP adherence and refusal of treatment. Further studies are required to address these areas in order to help develop more personalised treatment support that could be improved with additional communication modalities such as telemedicine.