A new characterization of adherence patterns to auto-adjusting positive airway pressure in severe obstructive sleep apnea syndrome: clinical and psychological determinants

Abstract

The aim of this study was to examine the joint role of demographic, clinical, psychological and family coping variables as predictors of adherence patterns to auto-adjusting positive airway pressure (APAP). A total of 153 patients diagnosed with obstructive sleep apnea syndrome (OSAS) were assessed during a 6-months APAP treatment period. All patients underwent psychological evaluation prior to treatment (T1) and 1 to 3months (T2) and 4 to 6months (T3) post-APAP treatment. Of these, 107 patients maintained a stable adherence pattern to APAP during the treatment period. Forty-seven percent were poorly adherent, 27% were moderately adherent and 26% were optimally adherent OSAS patients. Several factors distinguished the three adherence patterns and some of these emerged as the main predictors. In T1, the first model included age, apnea-hypopnea index, outcome expectations and coping spiritual support, as main predictors to distinguish adherence patterns. In T2 and T3, two models emerged adjusted to the variables of model 1 that included leakage, self-efficacy, mobilizing family acquire/accept support and reframing in model 2 and self-efficacy in model 3. Generally, the areas under the ROC curve, presented a good discrimination. Findings revealed an integrative heuristic model that accounted for the joint influence of demographic, clinical, psychological, and family coping factors on poor, moderate, and optimal adherence patterns.