Experienced benefits of noninvasive ventilation predict adherence more than the disease itself

Background: Noninvasive ventilation (NIV) is widely used in chronic respiratory insufficiency. The aim of this study was to assess which factors are associated with long-term compliance to NIV. Methods: We conducted a retrospective study including 447 patients starting NIV. Two university hospitals were included into this study, one from Finland (with 188 patients starting NIV 1.1.2012-31.12.2015) and one from the Netherlands (with 259 patients starting NIV 1.1.2015-1.12.2022 with available data on compliance). Compliance rates were collected within 3-12 months after initiation of NIV. Logistic regression with multivariate analysis was used to analyse which factors were associated with compliance. Results: A total of 447 patients were included with 183, 134 and 130 patients with chronic obstructive pulmonary disease (COPD), obesity-hypoventilation syndrome (OHS) and amyotrophic lateral sclerosis (ALS), respectively. Altogether 346 were compliant and 101 were non-compliant based on a cut-off of > or < 5 hours of use per day. In the multivariate analysis, only subjective benefits of NIV (OR 11.15, 95th CI 5.05-24.57, P < 0.001), no side effects (OR 0.49, 95th CI 0.26-0.93, P = 0.029) and higher inspiratory positive airway pressure (IPAP) (OR 1.13, 95th CI 1.04-1.23, P = 0.004) were associated with better compliance with NIV. Conclusions: In general, patients showed good adherence to NIV. However, usage hours were seen to be most influenced by the benefits of the device treatment and lower perceived side effects. Thus, in order to be successful with NIV, it would be important to effectively eliminate side effects and to get patients to experience the benefits of NIV.