Long-term therapy with continuous positive airway pressure in obstructive sleep apnea: adherence, side effects and predictors of withdrawal - a 'real-life' study.

BACKGROUND Long-term adherence to positive airway pressure (PAP) treatment is essential in patients with obstructive sleep apnea syndrome (OSAS). OBJECTIVES The aim of the present study was to analyze treatment adherence under real-life conditions and factors associated with discontinuation of PAP therapy. METHODS Patients newly diagnosed with OSAS and started on PAP therapy were contacted by telephone after a minimum of 1 year. Side effects, quality of life, subjective treatment adherence and Epworth Sleepiness Scale (ESS) scores were assessed. Objective treatment adherence was calculated by reading the built-in run time counter of the PAP device. Anthropometric parameters, level of education, apnea-hypopnea index (AHI), ESS score and the type of PAP therapy prescribed at the time of the first stay in the sleep lab were collected retrospectively. RESULTS Median follow-up was 13 months (range 7-18 months). Of 303 patients (69 female, 234 male) available for this study, 191 patients (63%) still used the PAP device regularly ('users'), while 83 (27.4%) had definitively discontinued PAP treatment ('nonusers'). In the nonusers group, 29 patients (34.9%) discontinued PAP treatment within the first 3 months. In the users group, subjective PAP usage was 6.6 ± 1.5 h/night and objective adherence was 4.7 ± 2.3 h/night. Objective nightly use of PAP treatment correlated significantly with baseline AHI (r = 0.13, p = 0.041) but not with sex, age, body mass index, ESS score or education level. Patients with a low AHI and ESS score and patients without a coexisting medical condition or with more than two comorbidities tended to discontinue PAP therapy more frequently. CONCLUSIONS PAP treatment adherence has to be optimized in OSAS patients. When initiating PAP therapy, clinicians have to focus on those patients at risk for discontinuing treatment. Education sessions and closer follow-up are possible strategies to improve treatment adherence and to avoid treatment discontinuation.