Determinants and rate of long-term adherence to continuous positive -airway pressure in obstructive sleep apnea: a multicenter retrospective study.

Abstract

Background: OSA is a chronic disorder associated with significant health and social risks. CPAP therapy is the gold standard treatment, but adherence remains a major challenge. Telemonitoring offers a potential tool to improve adherence and optimize long-term management. This multicenter observational retrospective study evaluates long-term CPAP adherence in OSA patients telemonitored in the province of Treviso, Italy. The primary objective is to evaluate adherence rates over a six-year period in comparison to existing data with conventional follow-up strategies. Secondary objectives include subgroup analyses based on age, sex, mask type, and the presence of comorbid respiratory conditions beyond OSA, such as OSA-obesity hypoventilation syndrome and complex sleep-related breathing disorders.

Methods: Data from 579 OSA patients who initiated CPAP therapy from July 2018 onwards were analyzed. Patients underwent routine telemonitoring follow-up every 3 months, during which CPAP adherence, residual apnea-hypopnea index, and air leakage were recorded. Statistical analyses included Welch's t-test, Mann-Whitney test, chi-square test, and Fisher's exact test, with significance set at p ≤ 0.05.

Results: The overall CPAP adherence rate was 80.66% over the 6-year follow-up period. Mean nightly usage was 6.6 hours, with a usage rate of 89.9% of nights. Elderly patients (>65 years) had higher rAHI (4.4 vs. 3) and air leakage (45.7% vs. 24.9%) compared to younger individuals but exhibited comparable adherence. Nasal masks were associated with superior adherence (6.8 vs. 6.4 hours per night) and lower rAHI (3.3 vs. 4.4) compared to oronasal masks. OSA patients with obesity-hypoventilation syndrome and complex sleep-related breathing disorders demonstrated similar adherence rates to general OSA patients, despite distinct characteristics.

Conclusions: In this first real-life study with a large sample size conducted in Italy so far, CPAP adherence in telemonitored patients was significantly higher compared to previous studies without telemonitoring. These findings suggest that telemonitoring enhances long-term adherence by facilitating early detection and management of nonadherence. The study highlights the advantages of nasal masks and emphasizes the greater challenges associated with managing elderly patients and those with comorbid conditions. Telemedicine appears to be a promising approach for optimizing OSA management.