Challenges of Positive Airway Pressure Treatment for Patients With Obstructive Sleep Apnea at a Veterans Medical Center

Objective Positive airway pressure (PAP) compliance is important in treating obstructive sleep apnea. Previous studies have suggested that patients with economic burdens, discomfort using machines, and insufficient education have difficulty tolerating PAP machines. This study explored the factors affecting short-term adherence to PAP in a veterans medical center.Methods The medical records of patients who underwent polysomnography at the Veterans Health Service Medical Center, Seoul, Republic of Korea, between July 2018 and January 2021 were reviewed retrospectively. Patients with an apnea-hypopnea index (AHI) ≥15 were included (n=579). PAP adherence was defined as continuous use for ≥21 days for ≥4 hours daily for 30 consecutive days for 90 days from the date of PAP prescription.Results The PAP-adherent group (n=265, age 66.16±11.28 years) was younger and had more years of education, higher body mass indices, and lower scores in the Insomnia Severity Index and Beck Depression Inventory-II (BDI-II) than those of the PAP-nonadherent group (n=314, age 68.93±10.91 years). Patients who tolerated PAP had a higher AHI, longer duration of oxygen desaturation (less than 90%), and less dream enactment behavior (DEB) than that in those who did not. After adjusting for age, years of education, BDI-II, duration of oxygen desaturation, and presence of DEB, there were more patients with National Health Insurance (NHI) in the PAP-adherent group than in the PAP-nonadherent group (p<0.001).Conclusion We showed that patients with NHI recorded significantly higher adherence compared to that in patients without NHI, among other factors.