Factors influencing adherence to nasal continuous positive airway pressure in obstructive sleep apnea patients in Japan

Adherence to nasal continuous positive airway pressure (n-CPAP) therapy is a clinically important requirement for obstructive sleep apnea (OSA); however, some patients often find difficulty even in continuing with treatment. We suggest that rather than the objective results such as the severity of OSA, adherence to n-CPAP therapy is more greatly influenced by the subjective factors of each patient, such as awareness of OSA, and adverse effects of treatment. We surveyed patients with OSA who initiated n-CPAP at our sleep center, with at least 12 months of follow-up data. In total, 937 patients, including those who had already discontinued therapy, were surveyed via questionnaires, 732 completed questionnaires. According to self-reported adherence data, patients were split into three groups (no-adherence, good adherence, and poor adherence). Furthermore, various issues with treatment were extracted using questionnaires and tabulated to retrospectively examine factors influencing adherence. The adherence rate was 78.1 % among 732 patients who initiated n-CPAP ≥1 year previously. Commonly reported issues in the non-adherence group were respiratory difficulty, insomnia/lack of sleep, and no effect of treatment felt/no improvement in symptoms. Similarly, air pressure discomfort and mask falling were significantly associated with poor adherence. Compared with objective data obtained using polysomnography, adherence may be more significantly influenced by subjective predictors, including clinical symptoms and intuitive complaints accompanying treatment. Our results suggested that the identification of patients with these predictors during the early phase after treatment initiation and continuous intervention for them may be the first step towards developing better adherence.