Beyond the Mask―Psychological Discomfort as a Predictor of Early CPAP Nonadherence in Moderate‐to‐Severe OSA Patients: A Prospective Mixed‐Methods Study

Background and Objective Early adherence to CPAP therapy is a critical determinant of long‐term treatment adherence, but it is frequently compromised by patient‐reported adverse effects. This study aimed to systematically identify CPAP‐related adverse symptoms and evaluate their associations with early treatment adherence among patients with moderate‐to‐severe OSA. Methods A prospective mixed‐methods study was conducted at a tertiary sleep center between August 2021 and February 2025. A total of 121 adults with newly diagnosed moderate‐to‐severe OSA were enrolled. CPAP‐related symptoms (n = 430) were collected through semistructured telephone interviews conducted at least three times. Symptoms were categorized into four domains: physiological, psychological, CPAP interface–related, and CPAP device–related. Early CPAP adherence over a 14‐day trial period was defined as CPAP use for ≥ 4 h per night on ≥ 70% of nights. Results Among 121 participants (mean age 50. 8 years; 84. 3% male), 60. 3% demonstrated good adherence. Psychological symptoms were the only domain significantly associated with reduced adherence (β = −7. 50%; p = 0. 049), with suffocation sensations showing a particularly strong negative impact (β = −37. 14%; p = 0. 018). Conversely, CPAP interface–related symptoms such as mask discomfort were positively associated with adherence (β = 12. 89%; p = 0. 011). Physiological and equipment‐related symptoms were not significantly associated with CPAP adherence. Conclusion Psychological discomfort significantly impairs early CPAP adherence among patients with OSA. Routine assessment and timely intervention targeting psychological and interface‐related complaints during the initial treatment period may help support continued CPAP use in clinical practice. Trail Registration: ClinicalTrials. govᵢdentifier: NCT06520592