Subjective and Objective CPAP Compliance in Patients with Obstructive Sleep Apnea Syndrome

Abstract

Physicians have considered continuous positive airway pressure (CPAP) to be the optimal therapy for patients with moderate to severe obstructive sleep apnea syndrome (OSAS).1 Patients with OSA can get many advantages from regular CPAP usage, including improvements in daytime sleepiness and nighttime sleep quality for both the patients and their bed partners;2,3 reduced risk of cardiovascular disease and neurocognitive impairment;4,5 and reduced risk of motor vehicle accidents.6,7 However, CPAP usage may cause certain discomforts that lower its acceptance and adherence rates.8 Since CPAP is a self-imposed treatment, researchers and clinicians have regarded compliance as the main determinant of CPAP success. Despite many attempts to improve CPAP treatment adherence, the treatment’s acceptance and adherence rates are still low.9 One comprehensive literature review of CPAP acceptance found that less than half of patients initiated CPAP therapy when their physicansc recommended CPAP therapy.10 Recently Simon-Tuval et al.11 found that only 40% of patients needing to use CPAP had actually purchased the device. A number of studies have tried to discern the factors that predict good adherence to CPAP treatment.2,10,12 The factors that increased CPAP adherence were increased severity of sleep apnea, greater daytime sleepiness, and perceived symptomatic benefits. However, previous studies found these factors did not prove consistently able to predict good compliance12,13 and several studies were limited by small sample sizes and short follow-up periods.14,15 Also, inconsistencies regarding the factors predicting good compliance might have resulted from different definitions of CPAP compliance and different ways of measuring compliance.13,16 Received: August 1, 2011 Accepted: August 18, 2011