Factors determining continuous positive airway pressure (CPAP) compliance in obstructive sleep apnea (OSA)

Abstract

Background: CPAP device is the gold standard therapy for OSA, though CPAP compliance remains problematic. Aims and Objectives: We aimed at evaluating the compliance to CPAP and at exploring potential predictors of compliance. Methods: This was a retrospective study at Hotel Dieu de France Hospital where we followed all patients diagnosed with OSA in the sleep center and treated for at least one day by CPAP between June 2008 and December 2014. Dropout events were noted. The Kaplan-Meier curve was used to estimate the median compliance time. Cox proportional hazards models were applied to determine independent predictive factors for short-term (3 months) and long-term compliance. Results: We followed 374 OSA patients. Mean apnea-hypopnea index (AHI) was 32.7±24.1/hour and mean sleep efficiency was 81.6±13.9%. Median compliance time was 957 days. 70.3% of patients were compliant at 6 months, but only 49.3% remained compliant at the end of the study. Cox models showed that use of nasal masks (HR 0.48 p 0.048) and higher oxygen desaturation index (ODI) (HR 0.98 p 0.048) were independently associated with short-term CPAP compliance. Buying the CPAP device (HR 0.18 p Conclusion: Short-term CPAP compliance was significantly associated with polysomnographic severity and mask type usage whereas long-term compliance was related to provider services and reported improvement. These attributes should be targeted in order to increase CPAP compliance in OSA patients. NCT02301923.