Skip to main content
SpringerLink
Log in

Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Background

Good adherence to continuous positive airway pressure (CPAP) treatment improves the patient’s quality of life and decreases the risk of cardiovascular disease. Previous studies that have analyzed the adherence to CPAP were performed in a sleep unit (SU) setting. The involvement of primary care (PC) in the management of obstructive sleep apnea (OSA) patients receiving CPAP treatment could introduce factors related to the adherence to treatment.

Objectives

The objective was to compare the baseline predictors of CPAP compliance in SU and PC settings.

Methods

OSA patients treated with CPAP were followed for 6 months in SU or PC setting. We included baseline clinical and anthropometrical variables, the Epworth Sleep Scale (ESS) score, the quality of life index, and the Charlson index. A logistic regression was performed for each group to determine the CPAP compliance predictors. Discrimination and calibration were performed using the area under the curve and Hosmer-Lemeshow tests.

Results

We included 191 patients: 91 in the PC group and 100 in the SU group. In 74.9% of the patients, the compliance was ≥ 4 h per day, with 80% compliance in the SU setting and 69.2% compliance in the PC setting (p = 0.087). The predictors of CPAP compliance were different between SU and PC settings. Body mass index, ESS, and CPAP pressure were predictors in the SU setting, and ESS, gender, and waist circumference were predictors in the PC setting.

Conclusions

The predictors of adequate CPAP compliance vary between SU and PC settings. Detecting compliance predictors could help in the planning of early interventions to improve CPAP adherence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177(9):1006–1014. doi:10.1093/aje/kws342

    Article  PubMed  PubMed Central  Google Scholar 

  2. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3(4):310–318. doi:10.1016/S2213-2600(15)00043-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Sánchez-de-la-Torre M, Campos-Rodriguez F, Barbé F (2013) Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med 1(1):61–72. doi:10.1016/S2213-2600(12)70051-6

    Article  PubMed  Google Scholar 

  4. Sánchez-de-la-Torre M, Nadal N, Cortijo A, Masa JF, Duran-Cantolla J, Valls J et al (2015) Role of primary care in the follow-up of patients with obstructive sleep apnoea undergoing CPAP treatment: a randomised controlled trial. Thorax 70(4):346–352. doi:10.1136/thoraxjnl-2014-206287

    Article  PubMed  Google Scholar 

  5. Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG et al (2013) Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial. JAMA 309(10):997–1004. doi:10.1001/jama.2013.1823

    Article  CAS  PubMed  Google Scholar 

  6. Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, Martínez-Alonso M, Carmona C, Barceló A et al (2012) Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA 307(20):2161–2168. doi:10.1001/jama.2012.4366

    Article  PubMed  Google Scholar 

  7. Bratton DJ, Stradling JR, Barbé F, Kohler M (2014) Effect of CPAP on blood pressure in patients with minimally symptomatic obstructive sleep apnoea: a meta-analysis using individual patient data from four randomised controlled trials. Thorax 69(12):1128–1135. doi:10.1136/thoraxjnl-2013-204993

    Article  PubMed  PubMed Central  Google Scholar 

  8. Martínez-García MA, Campos-Rodriguez F, Catalan-Serra P, Soler-Cataluña JJ, Almeida-González C (2012) La Cruz-Moron de I, et al. Cardiovascular mortality in obstructive sleep apnea in the elderly. Role of long-term CPAP treatment: a prospective observational trial. Am J Respir Crit Care Med 186(9):909–916. doi:10.1164/rccm.201203-0448OC

    Article  PubMed  Google Scholar 

  9. Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5(2):173–178. doi:10.1513/pats.200708-119MG

    Article  PubMed  PubMed Central  Google Scholar 

  10. Siccoli MM, Pepperell JCT, Kohler M, Craig SE, Davies RJO, Stradling JR (2008) Effects of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: data from a randomized controlled trial. Sleep 31(11):1551–1558

    Article  PubMed  PubMed Central  Google Scholar 

  11. Martínez-García MA, Capote F, Campos-Rodriguez F, Lloberes P (2013) Díaz de Atauri MJ, Somoza M, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 310(22):2407–2415. doi:10.1001/jama.2013.281250

    Article  PubMed  Google Scholar 

  12. Collen J, Lettieri C, Kelly W, Roop S (2009) Clinical and polysomnographic predictors of short-term continuous positive airway pressure compliance. Chest 135(3):704–709. doi:10.1378/chest.08-2182

    Article  PubMed  Google Scholar 

  13. Kohler M, Smith D, Tippett V, Stradling JR (2009) Predictors of long-term compliance with continuous positive airway pressure. Thorax 135(3):704–709. doi:10.1378/chest.08-2182

    Google Scholar 

  14. Krieger J, Kurtz D, Petiau C, Sforza E, Trautmann D (1996) Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep 19(9 Suppl):S136–S143

    Article  CAS  PubMed  Google Scholar 

  15. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(4 Pt 1):1108–1114

    Article  CAS  PubMed  Google Scholar 

  16. Pelletier-Fleury N, Rakotonanahary D, Fleury B (2001) The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox’s proportional hazard analysis. Sleep Med 2(3):225–232

    Article  CAS  PubMed  Google Scholar 

  17. Hoffstein V, Viner S, Mateika S, Conway J (1992) Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 145(4 Pt 1):841–845

    Article  CAS  PubMed  Google Scholar 

  18. Campos-Rodriguez F, Martínez-Alonso M, Sánchez-de-la-Torre M, Barbé F, Network SS (2016) Long-term adherence to continuous positive airway pressure therapy in non-sleepy sleep apnea patients. Sleep Med 17:1–6. doi:10.1016/j.sleep.2015.07.038

    Article  PubMed  Google Scholar 

  19. Antic NA, Buchan C, Esterman A, Hensley M, Naughton MT, Rowland S et al (2009) A randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea. Am J Respir Crit Care Med 179(6):501–508. doi:10.1164/rccm.200810-1558OC

    Article  PubMed  Google Scholar 

  20. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15(6):343–356

    Article  PubMed  PubMed Central  Google Scholar 

  21. Molina M, Hernandez L, Duran J, Farré R, Rubio R, Navajas D et al (2003) Protocol to evaluate automatic continuous positive airway pressure. Assessment of the usefulness of the Autoset-T device to determine optimal pressure for treating sleep apnea/hypopnea syndrome. Arch Bronconeumol 39(3):118–125

    Article  CAS  PubMed  Google Scholar 

  22. Jenkinson C, Davies RJ, Mullins R, Stradling JR (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 353(9170):2100–2105

    Article  CAS  PubMed  Google Scholar 

  23. Kohler M, Blair E, Risby P, Nickol AH, Wordsworth P, Forfar C et al (2009) The prevalence of obstructive sleep apnoea and its association with aortic dilatation in Marfan’s syndrome. Thorax 64(2):162–166. doi:10.1136/thx.2008.102756

    Article  CAS  PubMed  Google Scholar 

  24. Sin DD, Mayers I, Man GCW, Pawluk L (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121(2):430–435

    Article  PubMed  Google Scholar 

  25. Campos-Rodriguez F, Martinez-Garcia MA, Reyes-Nuñez N, Caballero-Martinez I, Almeida-Gonzalez CV, Catalan-Serra P et al (2013) Long-term continuous positive airway pressure compliance in females with obstructive sleep apnoea. Eur Respir J 42(5):1255–1262. doi:10.1183/09031936.00165812

    Article  PubMed  Google Scholar 

  26. Parthasarathy S, Subramanian S, Quan SF (2014) A multicenter prospective comparative effectiveness study of the effect of physician certification and center accreditation on patient-centered outcomes in obstructive sleep apnea. J Clin Sleep Med 10(3):243–249. doi:10.5664/jcsm.3518

  27. Ye L, Pien GW, Ratcliffe SJ, Bjornsdottir E, Arnardottir ES, Pack AI et al (2014) The different clinical faces of obstructive sleep apnoea: a cluster analysis. Eur Respir J 44(6):1600–1607. doi:10.1183/09031936.00032314

    Article  PubMed  Google Scholar 

  28. Pack AI (2016) Application of P4 medicine to obstructive sleep apnea: a roadmap for improving care? Ann Am Thorac Soc 13(9):1456–1467. doi:10.1513/AnnalsATS.201604-235PS

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all of the primary care personnel involved in the study and Maricel Arbonés, Olga Mínguez, and Lydia Pascual (Group of Translational Research in Respiratory Medicine, IRBLleida, Spain) for the kind support.

Author information

Authors and Affiliations

  1. Hospital Universitari Arnau de Vilanova and Santa Maria. IRBLleida, Lleida, Spain

    Núria Nadal, Jordi de Batlle, Ferran Barbé, Alicia Sánchez-de-la-Torre, Nuria Tarraubella & Manuel Sánchez-de-la-Torre

  2. Primary Care Unit of Lleida, Catalonia, Spain

    Núria Nadal, Nuria Tarraubella & Merce Lavega

  3. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain

    Ferran Barbé, Alicia Sánchez-de-la-Torre & Manuel Sánchez-de-la-Torre

  4. Lleida Research Support Unit, Primary Care Research Institute (IDIAP) Jordi Gol, Catalonia, Spain

    Josep Ramon Marsal

  5. Hospital Arnau de Vilanova-Santa María, CIBERES, IRBLleida, Avda. Rovira Roure 80, 25198, Lleida, Spain

    Manuel Sánchez-de-la-Torre

Authors
  1. Núria Nadal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jordi de Batlle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ferran Barbé
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josep Ramon Marsal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alicia Sánchez-de-la-Torre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nuria Tarraubella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Merce Lavega
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Manuel Sánchez-de-la-Torre
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: NN, JB, and MST. Data acquisition: NN, JB, FB, JRM, AST, NT, ML, and MST. Data analysis and interpretation: NN, JB, FB, JRM, and MST. Drafting of the manuscript: NN, JB, FB, and MST. Revision of the manuscript for intellectual content and approval of the final version: NN, JB, FB, JRM, AST, NT, ML, and MST. Guarantors of the study: FB and MST.

Corresponding author

Correspondence to Manuel Sánchez-de-la-Torre.

Ethics declarations

Funding

This research was supported by Fondo de Investigación Sanitaria (PI 13/02004), Fondo Europeo de Desarrollo Regional (FEDER), Una manera de hacer Europa, the Spanish Respiratory Society (SEPAR), and Esteve-Teijin (Spain). Co-funded by Ministerio de Economía y Competitividad [COFUND2014-51501]. The sponsor had no role in the design or conduct of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

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

Additional information

Núria Nadal and Jordi de Batlle are co-first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nadal, N., de Batlle, J., Barbé, F. et al. Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit. Sleep Breath 22, 157–163 (2018). https://doi.org/10.1007/s11325-017-1549-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1549-7

Keywords

Search

Navigation