Short-term compliance to continuous positive airway pressure in patients with moderate to severe obstructive sleep apnea

Background Obstructive sleep apnea (OSA) is a frequent clinical problem. Positive airway pressure (PAP) therapy is the cornerstone of treatment for OSA. Poor patient adherence to PAP therapy is commonly reported. Factors leading to nonadherence vary depending on the population studied. Objectives The primary objective was to assess the compliance to continuous positive airway pressure (CPAP) therapy in patients with moderate and severe OSA. The secondary objectives were to compare the improvement of clinical parameters in OSA patients who are compliant to CPAP therapy versus CPAP noncompliant group and to evaluate the factors predicting compliance to CPAP therapy. Patients and methods This was a single centre longitudinal prospective observational study spanning 3 months. Patients with moderate or severe OSA in whom a PAP titration has been done and have CPAP therapy prescribed by their treating doctor were recruited. Self-reported compliance to CPAP was assessed at 3 months and was crosschecked with the integrated chip available with the CPAP device. Improvement in sleepiness, systolic blood pressure, and cognitive function was compared between CPAP adherent and nonadherent patients. Appropriate statistical methods were employed to assess various factors that predict compliance to CPAP therapy. Results A compliance of 44% to CPAP at 3 months of therapy initiation was noted. Reduction in snoring was reported by 88% of CPAP adherent patients in comparison with 60% of nonadherent patients ( P <0.01). A two-point reduction in excessive daytime sleepiness was noted in 74% of CPAP compliant patients as opposed to 48% of noncompliant patients ( P <0.01). Improvement in cognitive function and a greater than or equal to 10 mmHg reduction in systolic pressure were noted in a higher proportion of regular CPAP users. Univariate regression analysis revealed baseline cognitive function, systolic blood pressure, oxygen desaturation Index, place of CPAP Titration, and usage of humidifier as predictors of CPAP compliance. Conclusion Compliance of moderate and severe OSA patients to CPAP therapy at 3 months is 44%. CPAP compliant patients have better clinical outcomes than noncompliant patients. The predictors of CPAP compliance have been spelt out.