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Low arousal threshold is associated with unfavorable shift of PAP compliance over time in patients with OSA

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

To determine the predictive factors of initial and long-term adherence to positive airway pressure (PAP) therapy and factors leading to an unfavorable shift of PAP compliance.

Methods

This follow-up study was comprised of newly diagnosed patients with obstructive sleep apnea (OSA) amenable to PAP therapy from January 2017 to April 2019. Information on basic demographics, comorbidities, and sleep-related symptoms were collected. PAP adherence data were collected at the end of the first week and the third month.

Results

Of 166 patients enrolled, data from 142 (86%) were in the final analysis. Overall PAP usage was worse at 3 months declining from the first week. After adjusting for age and gender, multinomial logistic regression analysis showed that a small number of sleep-related symptoms (OR, 0.69; 95% CI, 0.52–0.91) and low arousal threshold (ArTH) (OR, 4.44; 95% CI, 1.52–12.98) were associated with higher odds of noncompliance. Low ArTH (OR, 2.87; 95% CI, 1.09–7.57) and lower body mass index (BMI) (OR, 0.88; 95% CI, 0.78–0.99) increased the risk of compliance-to-noncompliance shift. Sixty-two patients with polysomnography were analyzed separately. After adjustment for age and gender, poor sleep efficiency (OR, 0.80; 95% CI, 0.68–0.94) was associated with higher odds of consistent noncompliance. Low ArTH (OR, 15.36; 95% CI, 1.44–164.24) increased the risk of compliance-to-noncompliance shift in this subgroup.

Conclusions

Lower BMI and low ArTH were associated with an unfavorable shift of PAP compliance over time in patients with OSA, which was different from the predictors of consistent PAP noncompliance of patients with OSA.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Dr. Q. Chen and C.Y. Ma for subject follow-up work. Stanley Yung-Chuan Liu, M.D., from the division of Sleep Surgery, Dept. of Otolaryngology-Head & Neck Surgery, at Stanford University School of Medicine, provided useful comments.

Funding

This study was financially supported by NSFC (Project 81870335) and Capital’s Funds for Health Improvement and Research (CFH-2020-4-1055).

Author information

Authors and Affiliations

  1. Sleep Medicine Center, Dept. of Otolaryngology-Head & Neck Surgery Beijing An Zhen Hospital, Capital Medical University, Beijing, China

    Hao Wu

  2. Sleep Medicine Center, Beijing An Zhen Hospital, Capital Medical University, Beijing, China

    Fang Fang, Chan Wu & Xiaojun Zhan

  3. Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China

    Fang Fang

  4. Beijing An Zhen Hospital, Capital Medical University, 2th Anzhen Road, Chaoyang District, Beijing, 100029, China

    Yongxiang Wei

Authors
  1. Hao Wu
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  2. Fang Fang
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  3. Chan Wu
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Contributions

WH and WY performed the study design and experiment operation, and were major contributors in writing the manuscript. WC and ZX performed the study design and data collection. FF analyzed and interpreted the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yongxiang Wei.

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Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board of Beijing An Zhen Hospital and was registered in the Chinese Clinical Trial Register (ChiCTR-ROC-17011027).

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

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

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Wu, H., Fang, F., Wu, C. et al. Low arousal threshold is associated with unfavorable shift of PAP compliance over time in patients with OSA . Sleep Breath 25, 887–895 (2021). https://doi.org/10.1007/s11325-020-02197-9

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  • DOI: https://doi.org/10.1007/s11325-020-02197-9

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