Impact of Randomization, Clinic Visits, and Medical and Psychiatric Cormorbidities on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea

Abstract

Study objectives: To evaluate factors associated with continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES) cohort.

Methods: The data from a prospective 6-mo multicenter randomized controlled trial with 558 subjects randomized to active CPAP and 547 to sham CPAP were analyzed to assess adherence to CPAP during first 2 mo (early period) and during months 5-6 (late period).

Results: Participants randomized to active CPAP had higher hours of nightly adherence compared to the sham CPAP group at both 2 (4.9 ± 2.0 h versus 4.07 ± 2.14 h, p < 0.001) and 6 mo (4.70 ± 2.08 h versus 3.41 ± 2.19 h, p < 0.001). Those assigned to sham CPAP were more likely to correctly identify their treatment group (70.0% versus 55.2%, p < 0.001). Irrespective of treatment group assignment, those who believed they were receiving active CPAP had higher hours of adherence than those who thought they were in the sham CPAP group at both 2 mo (4.91 ± 2.01 versus 4.17 ± 2.17, p < 0.001) and 6 mo (4.65 ± 2.10 versus 3.65 ± 2.22, p < 0.001). Among those randomized to active CPAP, older age was significantly related to CPAP use > 4 h per night. Presence of cardiovascular disorders was associated with higher hours of CPAP use, whereas presence of anxiety was associated with a trend toward lower hours of CPAP use. Presence of nasal congestion was associated with a decrease in mean daily CPAP use between the early and the late adherence period. The adherence during the week prior to a clinic visit was higher than the average adherence during the 2-mo period prior to the visit.

Conclusions: Randomization to active therapy, belief that one is in the active treatment group, older age, and possibly presence of cardiovascular disorders are positively linked to CPAP adherence. Nasal congestion and anxiety are negatively associated with CPAP adherence. CPAP nightly usage increases as clinic visits approach.

Keywords: CPAP; adherence; age; comorbid; compliance; continuous positive airway pressure; medical disorders; obstructive sleep apnea; psychiatric disorders; race; sex; sleep disordered breathing.

© 2016 American Academy of Sleep Medicine.

Figures

Figure 1

(A) Nightly adherence by visit and randomized study arm. Sample size is 1,105 (558 CPAP, 547 sham CPAP). (B) Nightly adherence by visit and participant guessed study arm. Sample size is 944 (484 CPAP, 460 sham CPAP). *p < 0.05 indicates statistical significance. CPAP, continuous positive airway pressure.

Figure 2

(A) Average nightly CPAP usage prior to the 2-mo clinic visit by duration of adherence measurement. During the early period (0–2 mo), the participants demonstrated a significant increase in CPAP adherence as the clinic visit approached. Sample size is 387 CPAP participants. (B) Average nightly CPAP usage prior to the 6-mo clinic visit by duration of adherence measurement. Similar to the early period of CPAP therapy, the participants demonstrated a significant increase in CPAP adherence as the clinic visit approached during the late period (5–6 mo). Sample size is 321 CPAP participants. *p < 0.05 indicates statistical significance for comparison with the 2-mo period.