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Risk assessment for CPAP nonadherence in adults with newly diagnosed obstructive sleep apnea: preliminary testing of the Index for Nonadherence to PAP (I-NAP)

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Abstract

Purpose

Identification of risk for continuous positive airway pressure therapy (CPAP) nonadherence prior to home treatment is an opportunity to deliver targeted adherence interventions. Study objectives included the following: (1) test a risk screening questionnaire to prospectively identify CPAP nonadherence risk among adults with newly diagnosed obstructive sleep apnea (OSA), (2) reduce the questionnaire to a minimum item set that effectively identifies 1-month CPAP nonadherence, and (3) examine the diagnostic utility of the screening index.

Methods

A prospective, longitudinal study at two clinical sleep centers in the USA included adults with newly diagnosed OSA (n = 97; AHI ≥5 events/h) by polysomnogram (PSG) consecutively recruited to participate. After baseline participant and OSA characteristics were collected, a risk screening questionnaire was administered immediately following CPAP titration polysomnogram. One-month objective CPAP use was collected.

Results

Predominantly, white (87 %), males (55 %), and females (45 %) with obesity (BMI 38.3 kg/m2; SD 9.3) and severe OSA (AHI 36.8; SD 19.7) were included. One-month CPAP use was 4.25 h/night (SD 2.35). Nineteen questionnaire items (I-NAP) reliably identified nonadherers defined at <4 h/night CPAP use (Wald X 2[8] = 34.67, p < 0.0001) with ROC AUC 0.83 (95 % CI 0.74–0.91). Optimal score cut point for the I-NAP screening questionnaire were determined to maximize sensitivity (87 %) while maintaining specificity >60 % (63 %).

Conclusion

A risk screening questionnaire employed immediately after titration PSG may reliably identify CPAP nonadherers and permit the delivery of targeted interventions to prevent or reduce nonadherence. This novel approach may enhance cost-effectiveness of care and permit appropriate allocation of resources for CPAP adherence.

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Acknowledgements

The project described was supported by Grant Numbers R00NR011173 and K99NR011173 from the National Institute of Nursing Research/National Institutes of Health. The authors acknowledge the sleep center staff members and providers who supported research recruitment, enrollment, and protocol procedures at the respective centers and early consultation with Greg Maislin, Biomedical Statistical Consulting and Judy A. Shea, PhD, University of Pennsylvania.

Conflict of interest

Drs. King, Hanlon, Sweer, and Rizzo disclose no conflicts of interest. Dr. Sawyer has received funding from National Institutes of Health/NINR, American Nurses Foundation and Sigma Theta Tau International and has received honoraria as an educational speaker for the American Academy of Sleep Medicine. Dr. Weaver discloses the following: Research equipment support from Philips Respironics, Inc.; Grant support from TEVA, Inc. (2008–13); FOSQ License Agreements with Nova Som, GlaxoSmithKline, Philips Respironics, Cephalon, Inc., and Nova Nordsk; and serves on the Board of Directors for ViMedicus, Inc. Dr. Weaver also has received research support from National Institutes of Health. Dr. Richards has received research support from Philips Respironics, Inc., National Institutes of Health, and the Department of Veterans Affairs.

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Authors and Affiliations

  1. College of Nursing, The Pennsylvania State University, 129C HHD East, University Park, PA, 16802, USA

    Amy M. Sawyer

  2. Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA, USA

    Tonya S. King

  3. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Alexandra Hanlon

  4. School of Nursing, College of Health and Human Services, George Mason University, Fairfax, VA, USA

    Kathy C. Richards

  5. Carlisle Regional Sleep Disorders Center, Carlisle, PA, USA

    Leon Sweer

  6. Sleep and Lung Health Enhancement, Pulmonary Associates, P.A., Newark, DE, USA

    Albert Rizzo

  7. College of Nursing, University of Illinois at Chicago, Chicago, IL, USA

    Terri E. Weaver

Authors
  1. Amy M. Sawyer
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  2. Tonya S. King
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  3. Alexandra Hanlon
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  4. Kathy C. Richards
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  5. Leon Sweer
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  6. Albert Rizzo
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  7. Terri E. Weaver
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Corresponding author

Correspondence to Amy M. Sawyer.

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Sawyer, A.M., King, T.S., Hanlon, A. et al. Risk assessment for CPAP nonadherence in adults with newly diagnosed obstructive sleep apnea: preliminary testing of the Index for Nonadherence to PAP (I-NAP). Sleep Breath 18, 875–883 (2014). https://doi.org/10.1007/s11325-014-0959-z

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  • DOI: https://doi.org/10.1007/s11325-014-0959-z

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