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Abstract Introduction Patient characteristics like self-efficacy, daytime sleepiness, and obstructive sleep apnea (OSA) severity are associated with positive airway pressure (PAP) treatment adherence. We examined the association of changes in sleep architecture with PAP titration on split-night polysomnography (PSG) with PAP adherence in an urban, racially diverse population. Methods PSG conducted between January and December 2019 were reviewed for sleep architecture data. The main variables were change in sleep efficiency (SE), arousal index (AI), N1, N3, and REM sleep. Changes were assessed as ratios and differences (therapeutic/diagnostic and therapeutic-diagnostic). Demographic data, body mass index (BMI), social vulnerability index (SVI), apnea hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and the initial 90-day adherence data from PAP download were collected. PAP adherence was defined as ≥4 hours/day use for ≥70% days. Stata v17 was used for analysis. Results PSG was conducted in 381 patients, and 239 patients had complete data for PAP use. The baseline characteristics of analyzed patients (N=239) were not significantly different from the missing sample (N=143). The PAP adherent group (N=109) were similar to the non-adherent group (N=130), except for a higher baseline ESS was noted in the adherent group (p=0.01). The logistic regression model showed that increasing age and lower ESS were associated with greater likelihood of PAP adherence (Odds Ratio, OR 1.02,95% confidence interval, CI 1.00-1.05 and OR 0.94, CI 0.89-0.99). Regarding the changes in sleep architecture with PAP titration, increases in SE and N3 sleep during the titration portion of the PSG were associated with higher likelihood of PAP adherence (OR 1.01, CI 1.00-1.03 for each). Changes in AI, N1, and REM sleep were not associated with PAP adherence. Conclusion Improvements in SE and an increase in N3 sleep during PAP titration on split-night PSG are associated with a higher likelihood of PAP adherence. Support (if any)
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