Background: Positive airway pressure (PAP) therapy is the standard treatment for obstructive sleep apnea syndrome (OSAS). Objectives: The aim of the current study was to determine operational long-term adherence to PAP and its predictors. Methods: In a retrospective single-center observational cohort study, we analyzed all patients referred to our center with suspected OSAS between November 2001 and November 2011. Baseline results and last follow-up data of each patient were analyzed. Kaplan-Meier estimates of adherence and Cox proportional hazard regression for age, gender, Epworth sleepiness scale (ESS) scores, body mass index, apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were performed. Evolution of adherence was analyzed in yearly cohorts comparing the proportion of patients discontinuing PAP within 6 and 12 months. Results: Of 4,638 referrals, 2,187 confirmed OSAS patients started PAP, 297 (14%) were referred out to other centers to follow-up, 42 (2%) died, and 92 (5%) no longer needed PAP. Of 1,756 patients, the median follow-up was 36 months [95% confidence interval (CI) 33.6-37.8], and adherence at 1, 5 and 10 years was 74 (CI 71-75; n = 1,028), 55 (CI 53-58; n = 281) and 51% (CI 48-55; n = 10), respectively. Adherence is associated with ESS score [hazard ratio (HR) 0.60; CI 0.47-0.78], ODI (HR 0.50; CI 0.32-0.77) and AHI (HR 0.56; CI 0.37-0.85). In yearly cohorts according to inclusion date, the absconder rate at 6 and 12 months was 20 (CI 18-22) and 27% (CI 25-30) for the first 8 years and improved to 10 (CI 7-15) and 14% (CI 10-19) for the last 2 years, respectively. Conclusions: Long-term adherence to PAP in OSAS is associated with baseline measures of disease severity. After 2009, an improvement in the adherence rate was observed.

Keywords:
Continuous positive airway pressure, Multivariate analysis , Patient compliance, Sleep apnea syndromes, Quality of care
1.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S: The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-1235.
2.
Antonopoulos CN, Sergentanis TN, Daskalopoulou SS, Petridou ET: Nasal continuous positive airway pressure (nCPAP) treatment for obstructive sleep apnea, road traffic accidents and driving simulator performance: a meta-analysis. Sleep Med Rev 2011;15:301-310.
3.
Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R, Jagia P, Kumar A: CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med 2011;365:2277-2286.
4.
Peppard PE, Young T, Palta M, Skatrud J: Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-1384.
5.
Marin JM, Carrizo SJ, Vicente E, Agusti AG: Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-1053.
6.
Kirby T: Colin Sullivan: inventive pioneer of sleep medicine. Lancet 2011;377:1485.
7.
Rapoport DM, Sorkin B, Garay SM, Goldring RM: Reversal of the ‘Pickwickian syndrome' by long-term use of nocturnal nasal-airway pressure. N Engl J Med 1982;307:931-933.
8.
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD: Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-276.
9.
Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ: Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006;3:CD001106.
10.
Smith I, Nadig V, Lasserson TJ: Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2009;2:CD007736.
11.
Galetke W, Puzzo L, Priegnitz C, Anduleit N, Randerath WJ: Long-term therapy with continuous positive airway pressure in obstructive sleep apnea: adherence, side effects and predictors of withdrawal - a ‘real-life' study. Respiration 2011;82:155-161.
12.
McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ: Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 1999;159:1108-1114.
13.
Kohler M, Smith D, Tippett V, Stradling JR: Predictors of long-term compliance with continuous positive airway pressure. Thorax 2010;65:829-832.
14.
Bloch KE, Schoch OD, Zhang JN, Russi EW: German version of the Epworth Sleepiness Scale. Respiration 1999;66:440-447.
15.
Gagnadoux F, Le VM, Goupil F, Pigeanne T, Chollet S, Masson P, Humeau MP, Bizieux-Thaminy A, Meslier N: Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients. PLoS One 2011;6:e22503.
16.
Pamidi S, Knutson KL, Ghods F, Mokhlesi B: The impact of sleep consultation prior to a diagnostic polysomnogram on continuous positive airway pressure adherence. Chest 2012;141:51-57.
17.
Randerath WJ, Schraeder O, Galetke W, Feldmeyer F, Ruhle KH: Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med 2001;163:652-657.
18.
Kohler M, Stoewhas AC, Ayers L, Senn O, Bloch KE, Russi EW, Stradling JR: Effects of continuous positive airway pressure therapy withdrawal in patients with obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med 2011;184:1192-1199.
19.
Martinez-Garcia MA, Campos-Rodriguez F, Catalan-Serra P, Soler-Cataluna JJ, Almeida-Gonzalez C, De la Cruz Moron I, Duran-Cantolla J, Montserrat JM: Cardiovascular mortality in obstructive sleep apnea in the elderly. Role of long-term CPAP treatment: a prospective observational trial. Am J Respir Crit Care Med 2012;186:909-916.
© 2013 S. Karger AG, Basel
2013
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