Adherence predictors to positive airway pressure (PAP) treatment in patients with obstructive sleep apnea (OSA)

Abstract

Background: Adherence to PAP treatment is a mainstay in the management of patients (pts) with OSA, although this is often difficult to attain and to maintain in the long term. At our outpatient clinic each patient is evaluated along the time by a multidisciplinary team, being expected that this follow-up program will allow an improved adherence to PAP therapy. Methods: An observational and retrospective longitudinal study was conducted analyzing age, anthropometric, clinical, diagnostic and treatment-related variables over a predefined timeline (initial, 3, 6 and 12 months). Multilevel mixed-effects linear regression models were used to analyze data, and a significance level, α = 0.05, was used. Results: Were analyzed 133 pts. OSA severity was: Severe (70%); Moderate (22%); Mild (8%). Most prevalent PAP mode was Auto-CPAP (86%), with nasal mask (65%) and the most frequent prescribed pressures were 4-12 cmH2O. PAP usage ≥ 90% of total time / usage ≥ 4h/night was 66%/70%, 69%/81%, 71%/90% and 69%/88%, at initial, 3, 6 and 12 M, respectively. The usage ≥ 4h/night had an increasing trend with the time of therapy (p l0.001, comparing initial with 3M, 6M and 12M). AIH and Epworth scale have been significantly improved to normal values (p l0.001). The most frequent complications were excessive leakage, nasal obstruction, excessive pressure and dry mouth. Multivariate analysis showed that higher adherence values (usage ≥ 4h/night) are associated with older ages, higher oxygen dessaturation index and absence of complications (p≤0.001). Conclusion: Our program has a good performance regarding treatment efficacy, with a low prevalence of complications and improved in-night adherence.