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Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea

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Abstract

Obstructive sleep apnea (OSA) is a common disease which impacts quality of life, mood, cardiovascular morbidity, and mortality. Continuous positive airway pressure (CPAP) is the first-line treatment for patients with moderate to severe OSA. CPAP ameliorates respiratory disturbances, leading to improvements in daytime sleepiness, quality of life, blood pressure, and cognition. However, despite the high efficacy of this device, CPAP adherence is often sub-optimal. Factors including: socio-demographic/economic characteristics, disease severity, psychological factors, and side-effects are thought to affect CPAP adherence in OSA patients. Intervention studies have suggested that augmented support/education, behavioral therapy, telemedicine and technological interventions may improve CPAP adherence. In this paper, we will extensively review the most common factors including age, gender, race/ethnicity, socioeconomic status, smoking status, severity of OSA, severity of OSA symptoms, psychological variables, social support, marital status/bed partner involvement, dry nose and mouth, mask leak, and nasal congestion that may predict CPAP adherence. We will also extensively review interventions that may increase adherence to CPAP.

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References

  1. Sullivan C, Berthon-Jones M, Issa F, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 317(8225):862–865

    Article  Google Scholar 

  2. Rotenberg BW, Murariu D, Pang KP (2016) Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 45(1):43

    Article  PubMed  PubMed Central  Google Scholar 

  3. Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P et al (2007) Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 30(3):320–324

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  5. Anttalainen U, Saaresranta T, Kalleinen N, Aittokallio J, Vahlberg T, Polo O (2007) CPAP adherence and partial upper airway obstruction during sleep. Sleep Breath 11(3):171–176

    Article  PubMed  Google Scholar 

  6. Billings ME, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Redline S et al (2011) Race and residential socioeconomics as predictors of CPAP adherence. Sleep 34(12):1653–1658

    Article  PubMed  PubMed Central  Google Scholar 

  7. Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A (2009) Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep 32(4):545–552

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gulati A, Ali M, Davies M, Quinnell T, Smith I (2017) A prospective observational study to evaluate the effect of social and personality factors on continuous positive airway pressure (CPAP) compliance in obstructive sleep apnoea syndrome. BMC Pulm Med 17(1):56

    Article  PubMed  PubMed Central  Google Scholar 

  9. Reeves-Hoche MK, Meck R, Zwillich CW (1994) Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med 149(1):149–154

    Article  CAS  PubMed  Google Scholar 

  10. Russo-Magno P, O’Brien A, Panciera T, Rounds S (2001) Compliance with CPAP therapy in older men with obstructive sleep apnea. J Am Geriatr Soc 49(9):1205–1211

    Article  CAS  PubMed  Google Scholar 

  11. Campos-Rodriguez F, Martinez-Alonso M, Sanchez-de-la-Torre M, Barbe F, Spanish Sleep Network (2016) Long-term adherence to continuous positive airway pressure therapy in non-sleepy sleep apnea patients. Sleep Med 17:1–6

    Article  PubMed  Google Scholar 

  12. Kohler M, Smith D, Tippett V, Stradling JR (2010) Predictors of long-term compliance with continuous positive airway pressure. Thorax 65(9):829–832

    Article  PubMed  Google Scholar 

  13. 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(suppl_9):S136–S143

    Article  CAS  PubMed  Google Scholar 

  14. 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):1108–1114

    Article  CAS  PubMed  Google Scholar 

  15. Rudkowski JC, Verschelden P, Kimoff RJ (2001) Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea. Eur Respir J 18(3):535–541

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  Google Scholar 

  17. McArdle N, Kingshott R, Engleman HM, Mackay TW, Douglas NJ (2001) Partners of patients with sleep apnoea/hypopnoea syndrome: effect of CPAP treatment on sleep quality and quality of life. Thorax 56(7):513–518

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Pépin JLD, Langevin B, Robert D, Lévy P (1995) Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: study of 193 patients in two French sleep centers. Chest 107(2):375–381

    Article  PubMed  Google Scholar 

  19. Virk JS, Kotecha B (2016) When continuous positive airway pressure (CPAP) fails. J Thorac Dis 8(10):E1112

    Article  PubMed  PubMed Central  Google Scholar 

  20. Berthon-Jones M, Calluaud M, Lynch CE, Hely KF (1996) U.S. Patent No. 5,560,354. Washington, DC: U.S. Patent and Trademark Office

  21. Rowland S, Aiyappan V, Hennessy C, Catcheside P, Chai-Coezter CL, McEvoy RD, Antic NA (2018) Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med 14(01):101–108

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wiese HJ, Boethel C, Phillips B, Wilson JF, Peters J, Viggiano T (2005) CPAP compliance: video education may help! Sleep Med 6(2):171–174

    Article  Google Scholar 

  23. Meurice JC, Ingrand P, Portier F, Arnulf I, Rakotonanahari D, Fournier E et al (2007) A multicentre trial of education strategies at CPAP induction in the treatment of severe sleep apnoea–hypopnoea syndrome. Sleep Med 8(1):37–42

    Article  PubMed  Google Scholar 

  24. Golay A, Girard A, Grandin S, Métrailler JC, Victorion M, Lebas P et al (2006) A new educational program for patients suffering from sleep apnea syndrome. Patient Educ Counsel 60(2):220–227

    Article  Google Scholar 

  25. Demolles DA, Sparrow D, Gottlieb DJ, Friedman R (2004) A pilot trial of a telecommunications system in sleep apnea management. Med care 42(8):764–769

    Article  PubMed  Google Scholar 

  26. Smith CE, Dauz ER, Clements F, Puno FN, Cook D, Doolittle G, Leeds W (2006) Telehealth services to improve nonadherence: a placebo-controlled study. Telemed J e-Health 12(3):289–296

    Article  PubMed  Google Scholar 

  27. Aloia MS, Dio L Di, Ilniczky N, Perlis ML, Greenblatt DE, Giles DE (2001) Improving compliance with nasal CPAP and vigilance in older adults with OSAHS. Sleep Breath 5(1):13–21

    Article  CAS  PubMed  Google Scholar 

  28. Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR (2007) Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep 30(5):635–640

    Article  PubMed  Google Scholar 

  29. Massie CA, Hart RW, Peralez K, Richards GN (1999) Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest J 116(2):403–408

    Article  CAS  Google Scholar 

  30. Schwab RJ, Badr SM, Epstein LJ et al (2013) An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med 188:613–620

    Article  PubMed  PubMed Central  Google Scholar 

  31. Scharf SM, Seiden L, DeMore J, Carter-Pokras O (2004) Racial differences in clinical presentation of patients with sleep-disordered breathing. Sleep Breath 8(04):173–183

    Article  PubMed  Google Scholar 

  32. Means MK, Ulmer CS, Edinger JD (2010) Ethnic differences in continuous positive airway pressure (CPAP) adherence in veterans with and without psychiatric disorders. Behav Sleep Med 8(4):260–273

    Article  PubMed  Google Scholar 

  33. 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 

  34. May AM, Gharibeh T, Wang L, Hurley A, Walia H, Strohl KP, Mehra R (2018) CPAP adherence predictors in a randomized controlled trial enriched with women and minorities. Chest 154:567–578

    Article  Google Scholar 

  35. Rezaie L, Phillips D, Khazaie H (2018) Barriers to acceptance and adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea: a report from Kermanshah province, western iran. Patient Preference Adherence 12:1299

    Article  PubMed  Google Scholar 

  36. Jacobsen AR, Eriksen F, Hansen RW, Erlandsen M, Thorup L, Damgård MB et al (2017) Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. PLoS ONE 12(12):e0189614. https://doi.org/10.1371/journal.pone.0189614

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Wild MR, Engleman HM, Douglas NJ, Espie CA (2004) Can psychological factors help us to determine adherence to CPAP? A prospective study. Eur Respir J 24(3):461–465

    Article  CAS  PubMed  Google Scholar 

  38. Stepnowsky CJ, Marler MR, Ancoli-Israel S (2002) Determinants of nasal CPAP compliance. Sleep Med 3(3):239–247

    Article  PubMed  Google Scholar 

  39. Bachour A, Maasilta P (2004) Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy. Chest 126(4):1248–1254

    Article  PubMed  Google Scholar 

  40. Hevener B, Hevener W (2016) Continuous positive airway pressure therapy for obstructive sleep apnea: maximizing adherence including using novel information technology-based systems. Sleep Med Clin 11(3):323–329

    Article  PubMed  Google Scholar 

  41. Sparrow D, Aloia M, DeMolles DA, Gottlieb DJ (2010) A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax 65(12):1061–1066

    Article  PubMed  Google Scholar 

  42. Weaver TE (2006) Adherence to positive airway pressure therapy. Curr Opin Pulm Med 12(6):409–413

    Article  PubMed  Google Scholar 

  43. Reid JPA-C (1996) A Telemedicine Primer: Understanding the Issues. Innovative Medical Communications (Billings, MT)

  44. Kwiatkowska M, Ayas N (2010) Can telemedicine improve CPAP adherence? Thorax 65(12):1035–1036. https://doi.org/10.1136/thx.2010.140897

    Article  PubMed  Google Scholar 

  45. Fox N, Hirsch-Allen AJ, Goodfellow E, Wenner J, Fleetham J, Ryan CF et al (2012) The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 35(4):477–481

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hwang D, Chang JW, Benjafield AV, Crocker ME, Kelly C, Becker KA et al (2018) Effect of telemedicine education and telemonitoring on continuous positive airway pressure adherence. The tele-OSA randomized trial. Am J Respir Crit Care Med 197(1):117–126

    Article  PubMed  Google Scholar 

  47. Taylor Y, Eliasson A, Andrada T, Kristo D, Howard R (2006) The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome. Sleep Breath 10(3):132–138

    Article  PubMed  Google Scholar 

  48. Bartlett D, Wong K, Richards D, Moy E, Espie CA, Cistulli PA, Grunstein R (2013) Increasing adherence to obstructive sleep apnea treatment with a group social cognitive therapy treatment intervention: a randomized trial. Sleep 36(11):1647–1654

    Article  PubMed  PubMed Central  Google Scholar 

  49. Billings ME, Rosen CL, Wang R, Auckley D, Benca R, Foldvary-Schaefer N et al (2013) Is the relationship between race and continuous positive airway pressure adherence mediated by sleep duration? Sleep 36(2):221–227

    PubMed  PubMed Central  Google Scholar 

  50. Pieh C, Bach M, Popp R, Jara C, Crönlein T, Hajak G, Geisler P (2013) Insomnia symptoms influence CPAP compliance. Sleep Breath 17(1):99–104

    Article  PubMed  Google Scholar 

  51. El-Solh AA, Adamo D, Kufel T (2018) Comorbid insomnia and sleep apnea in Veterans with post-traumatic stress disorder. Sleep Breath 22(1):23–31

    Article  PubMed  Google Scholar 

  52. Ritterband LM, Thorndike FP, Gonder-Frederick LA, Magee JC, Bailey ET, Saylor DK, Morin CM (2009) Efficacy of an internet-based behavioral intervention for adults with insomnia. Arch Gen Psychiatry 66(7):692–698

    Article  PubMed  PubMed Central  Google Scholar 

  53. Gooneratne NS, Gehrman P, Gurubhagavatula I, Al-Shehabi E, Marie E, Schwab R (2010) Effectiveness of ramelteon for insomnia symptoms in older adults with obstructive sleep apnea: a randomized placebo-controlled pilot study. J Clin Sleep Med JCSM 6(6):572

    PubMed  Google Scholar 

  54. Edinger JD, Means MK (2005) Cognitive–behavioral therapy for primary insomnia. Clin Psychol Rev 25(5):539–558

    Article  PubMed  Google Scholar 

  55. Weaver TE, Sawyer AM (2010) Adherence to continuous positive airway pressure treatment for obstructive sleep apnea: implications for future interventions. Indian J Med Res 131:245

    PubMed  PubMed Central  Google Scholar 

  56. Lai AY, Fong DY, Lam JC, Weaver TE, Ip MS (2014) The efficacy of a brief motivational enhancement education program on CPAP adherence in OSA: a randomized controlled trial. Chest 146(3):600–610

    Article  PubMed  Google Scholar 

  57. Aloia MS, Arnedt JT, Strand M, Millman RP, Borrelli B (2013) Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 36(11):1655–1662

    Article  PubMed  PubMed Central  Google Scholar 

  58. Bakker JP, Wang R, Weng J, Aloia MS, Toth C, Morrical MG et al (2016) Motivational enhancement for increasing adherence to CPAP: a randomized controlled trial. Chest 150(2):337–345

    Article  PubMed  PubMed Central  Google Scholar 

  59. Parthasarathy S, Wendel C, Haynes PL, Atwood C, Kuna S (2013) A pilot study of CPAP adherence promotion by peer buddies with sleep apnea. J Clin Sleep Med JCSM 9(6):543

    PubMed  Google Scholar 

  60. University of Arizona (2017) Peer-driven intervention for sleep apnea (PCORI). U.S. National Library of Medicine website. https://clinicaltrials.gov/ct2/show/NCT02056002#outcomemeasures. Accessed 5 Jan 2019

  61. Neuzeret PC, Morin L (2017) Impact of different nasal masks on CPAP therapy for obstructive sleep apnea: a randomized comparative trial. Clin Respir J 11(6):990–998

    Article  PubMed  Google Scholar 

  62. Genta PR, Lorenzi-Filho G (2018) Sealing the leak: a step forward in improving CPAP adherence. Chest 153(4):774–775

    Article  PubMed  Google Scholar 

  63. Ebben MR, Oyegbile T, Pollak CP (2012) The efficacy of three different mask styles on a PAP titration night. Sleep Med 13(6):645–649

    Article  PubMed  Google Scholar 

  64. Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B et al (2013) Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS ONE 8(5):e64382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Pépin JL, Leger P, Veale D, Langevin B, Robert D, Lévy P (1995) Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: study of 193 patients in two French sleep centers. Chest 107(2):375–381

    Article  PubMed  Google Scholar 

  66. Mador MJ, Krauza M, Pervez A, Pierce D, Braun M (2005) Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure. Chest 128(4):2151–2158

    Article  PubMed  Google Scholar 

  67. Ayas NT, Patel SR, Malhotra A, Schulzer M, Malhotra M, Jung D et al (2004) Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep 27(2):249–253

    Article  PubMed  Google Scholar 

  68. Bakker JP, Marshall NS (2011) Flexible pressure delivery modification of continuous positive airway pressure for obstructive sleep apnea does not improve compliance with therapy: systematic review and meta-analysis. Chest 139(6):1322–1330

    Article  PubMed  Google Scholar 

  69. Malhotra A, Crocker ME, Willes L, Kelly C, Lynch S, Benjafield AV (2018) Patient engagement using new technology to improve adherence to positive airway pressure therapy: a retrospective analysis. Chest 153(4):843–850

    Article  PubMed  Google Scholar 

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Funding

Ms. Mehrtash was partially supported by the Canadian Sleep and Circadian Network (CSCN) which is funded by CIHR.

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Authors and Affiliations

  1. Experimental Medicine Program, Department of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada

    M. Mehrtash

  2. Sleep Disorders Program, UBC Hospital, Vancouver, BC, Canada

    M. Mehrtash & N. Ayas

  3. Division of Sleep & Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA

    J. P. Bakker

  4. Respiratory and Critical Care Divisions, Department of Medicine, UBC, Vancouver, BC, Canada

    N. Ayas

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  1. M. Mehrtash
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  2. J. P. Bakker
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  3. N. Ayas
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All authors contributed substantially to this work.

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Correspondence to N. Ayas.

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Conflict of interest

Jessie Bakker is a full-time employee of Philips Respironics, a company that focuses on sleep and respiratory care. She has a part-time appointment at Brigham and Women’s Hospital. Dr. Bakker’s interests were reviewed and are managed by BWH and Partners HealthCare in accordance with their conflict of interest policies. Dr. Ayas is part of the Scientific Advisory Board of Bresotec, a company that makes diagnostic sleep apnea equipment.

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Mehrtash, M., Bakker, J.P. & Ayas, N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 197, 115–121 (2019). https://doi.org/10.1007/s00408-018-00193-1

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