Factors that predict adherence to continuous positive airway pressure treatment in obstructive sleep apnea patients: A prospective study in Japan

As adherence to continuous positive airway pressure (CPAP) therapy is crucial in the successful management of obstructive sleep apnea (OSA), identification of the many factors that affect adherence is important. To identify these factors among OSA patients in Japan, a nation with a unique health insurance system, complete sets of data were collected from 101 patients who had undergone overnight diagnostic polysomnography and 6months of therapy, and the data were subjected to univariate and multivariate analysis. The data included patient responses to sets of questionnaires containing items regarding a variety of factors that the patients had completed before undergoing overnight polysomnography for CPAP titration and initiating use of a treatment device. At the end of the treatment period, the participants were classified into 1 of 3 (non-adherence, poor adherence, and good adherence) CPAP adherence groups for analysis of differences among them. Multiple regression analysis of the variables identified as significant by univariate analysis (adjusted R ²= 0.370) indicated that CPAP adherence is positively associated with relatively high sleep efficiency at the time of titration (P < 0.01), earlier bedtime (P < 0.001), worse subjective sleep quality before therapy initiation (P= 0.001), higher motivation to use CPAP before therapy initiation (P < 0.05), and professional status as an occupational driver (P < 0.05). Analysis of the results indicates that CPAP adherence in Japanese OSA patients is associated with higher motivation to use CPAP but not with income level, which may be related to the uniqueness of the Japanese health insurance system.