Patient preferences and experiences of CPAP and oral appliances for the treatment of obstructive sleep apnea: a qualitative analysis



The aim of this study is to better understand patients’ perspectives and preferences about treatment with continuous positive airway pressure (CPAP) and oral appliance (OA) devices for obstructive sleep apnea.


The current study used qualitative analysis of four focus group sessions with current CPAP and OA users. Twenty-two participants with OSA who currently use either CPAP or OA participated in the sessions at the University of British Columbia.


Five topics from the focus group sessions were descriptively analyzed using NVivo software: goals and expectations of treatment, benefits of treatment for bed partners, side effects and inconveniences of CPAP, side effects and inconveniences of OA, and factors impacting treatment choice. In order of most to least frequently mentioned, patients expressed six expectations of treatment: improved health, apnea elimination, improved sleep, reduced fatigue, reduced snoring, and bed-partner benefits. The most to least mentioned factors impacting treatment choice were device effectiveness, transportability, embarrassment, and cost.


This qualitative study showed that many factors impact patients’ experience with their treatment device and that their treatment needs are not only physical but also relate to their lifestyle. This preliminary study provides treatment characteristics and attributes necessary to develop a quantitative questionnaire study, to assist in the selection of therapy, weighing the relative importance of patient and OSA treatment characteristics on treatment preference and adherence. Matching therapy to patient preferences may help identify the most appropriate treatment, and this may achieve greater likelihood of adherence.

This is a preview of subscription content, access via your institution.


  1. 1.

    Goncalves MA, Paiva T, Ramos E, Guilleminault C (2004) Obstructive sleep apnea syndrome, sleepiness, and quality of life. Chest 125(6):2091–2096

    PubMed  Article  Google Scholar 

  2. 2.

    Young T, Skatrud J, Peppard PE (2004) Risk factors for obstructive sleep apnea in adults. JAMA 291(16):2013–2016

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    George CFP (2007) Sleep apnea, alertness, and motor vehicle crashes. Am J Respir Crit Care Med 176(10):954–956

    PubMed  Article  Google Scholar 

  4. 4.

    Mulgrew AT, Nasvadi G, Butt A, Cheema R, Fox N, Fleetham JA, Ryan CF, Cooper P, Ayas NT (2008) Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax 63(6):536–541

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053

    PubMed  Google Scholar 

  6. 6.

    Shapiro GK, Shapiro CM (2010) Factors that influence CPAP adherence: an overview. Sleep Breath 14:323–335

    PubMed  Article  Google Scholar 

  7. 7.

    Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29(2):244–262

    PubMed  Google Scholar 

  8. 8.

    McCombs J, Nichol M, Newman C, Sclar D (1994) The costs of interrupting antihypertensive drug therapy in a Medicaid population. Med Care 32(3):214–226

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Bansback NJ, Anis AH, Marra CA (2008) Patient reported outcomes for rheumatoid arthritis: where are we and where are we going? J Rheumatol 35(8):1482–1483

    PubMed  Google Scholar 

  10. 10.

    Sabaté E, WHO Adherence to Long Term Therapies Project, Global Adherence Interdisciplinary Network, World Health Organization, Dept. of Management of Noncommunicable Diseases (2003) Adherence to long-term therapies: evidence for action. World Health Organization, Geneva

    Google Scholar 

  11. 11.

    Morgan DL (1988) Focus groups as qualitative research. Sage, Newbury Park

    Google Scholar 

  12. 12.

    Macnaghten P, Myers G (2004) Focus groups. In: Seale C, Gobo G, Gubrium JF, Silverman D (eds) Qualitative research practice. Sage, London, pp 312–326

    Google Scholar 

  13. 13.

    Roux L, Ubach C, Donaldson C, Ryan M (2004) Valuing the benefits of weight loss programs: an application of the discrete choice experiment. Obes Res 12(8):1342–1351

    PubMed  Article  Google Scholar 

  14. 14.

    Ryan M (2004) Discrete choice experiments in health care. BMJ 328(7436):360–361

    PubMed  Article  Google Scholar 

  15. 15.

    Sandelowski M (2000) Whatever happened to qualitative description? Res Nurs Heal 23(4):334–340

    Article  CAS  Google Scholar 

  16. 16.

    US Department of Labor (2010) Standard occupational classification. Bureau of Labor Statistics, available at Accessed July 6, 2011

  17. 17.

    Brostrom A, Arestedt K, Nilsen P, Stromberg A, Ulander M, Svanborg E (2010) The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment. J Sleep Res 19(4):603–611

    PubMed  Article  Google Scholar 

  18. 18.

    Almeida FR, Lowe AA (2009) Principles of oral appliance therapy for the management of snoring and sleep disordered breathing. Oral Maxillofac Surg Clin North Am 21(4):413–420

    PubMed  Article  Google Scholar 

  19. 19.

    Brostrom A, Stromberg A, Ulander M, Fridlund B, Martensson J, Svanborg E (2009) Perceived informational needs, side-effects and their consequences on adherence—a comparison between CPAP treated patients with OSAS and healthcare personnel. Patient Educ Couns 74(2):228–235

    PubMed  Article  Google Scholar 

  20. 20.

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

    PubMed  Article  Google Scholar 

  21. 21.

    Platt A, Field S, Asch D, Chen Z, Patel N, Gupta R, Roche D, Gurubhagavatula I, Christie J, Kuna S (2009) Neighborhood of residence is associated with daily adherence to CPAP therapy. Sleep 32:799–806

    PubMed  Google Scholar 

  22. 22.

    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 32:545–552

    PubMed  Google Scholar 

  23. 23.

    Taylor S (2006) Health psychology. McGraw Hill, Toronto

    Google Scholar 

  24. 24.

    Brostrom A, Nilsen P, Johansson P, Ulander M, Stromberg A, Svanborg E, Fridlund B (2009) Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: a qualitative content analysis. Sleep Medicine 11(2):126–130

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Fernanda R. Almeida.

Electronic supplementary material

Below is the link to the electronic supplementary material.


(DOCX 17 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Almeida, F.R., Henrich, N., Marra, C. et al. Patient preferences and experiences of CPAP and oral appliances for the treatment of obstructive sleep apnea: a qualitative analysis. Sleep Breath 17, 659–666 (2013).

Download citation


  • Sleep apnea
  • CPAP
  • Oral appliance
  • Snoring
  • Qualitative
  • Focus group
  • Adherence