Abstract
BackgroundCompliance with CPAP treatment for OSAS is not reliably predicted by the severity of symptoms or physiological variables. We examined a range of factors which could be measured before CPAP initiation to look for predictors of compliance.MethodsThis was a prospective cohort-study of CPAP treatment for OSAS, recording; socio-economic status, education, type D personality and clinician’s prediction of compliance.ResultsWe recruited 265 subjects, of whom 221 were still using CPAP at 6 months; median age 53 years, M: F, 3.4:1, ESS 15 and pre-treatment ODI 21/h. Median compliance at 6 months was 5.6 (3.4– 7.1) hours/night with 73.3% of subjects using CPAP ≥4 h/night. No association was found between compliance and different socio-economic classes for people in work, type D personality, education level, sex, age, baseline ESS or ODI. The clinician’s initial impression could separate groups of good and poor compliers but had little predictive value for individual patients. Compared to subjects who were working, those who were long term unemployed had a lower CPAP usage and were more likely to use CPAP < 4 h a night (OR 4.6; p value 0.011). A high Beck Depression Index and self-reported anxiety also predicted poor compliance.ConclusionsIn our practice there is no significant association between CPAP compliance with socio-economic status, education or personality type. Long term unemployed or depressed individuals may need more intensive support to gain the optimal benefit from CPAP.
Highlights
Compliance with Continuous positive airway pressure (CPAP) treatment for Obstructive sleep apnoea syndrome (OSAS) is not reliably predicted by the severity of symptoms or physiological variables
Patients who had a diagnosis of OSAS confirmed and were considered for CPAP treatment were approached to participate in the study
In this period 566 patients were initiated on CPAP therapy in the sleep centre, 410 of whom were first seen in clinic and were available for the study
Summary
Compliance with CPAP treatment for OSAS is not reliably predicted by the severity of symptoms or physiological variables. Obstructive sleep apnoea syndrome (OSAS) is a common condition, which can lead to low health status [1] through sleepiness, poor concentration and marital discord [2]. It increases the likelihood of accidents including road traffic collisions [3] and is probably an independent risk factor for cardiovascular mortality and Gulati et al BMC Pulmonary Medicine (2017) 17:56 reported to be as good as 84% [11] but historical series have reported that as few as 46% of initial acceptors subsequently used CPAP for more than 4 h/night [12]. More recent published work supported adopting a common sense patient centred approach, assessing medical, technical and behavioural factors in improving CPAP compliance [23]
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