title: Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients.
abstract: BACKGROUND
  Long-term adherence is a major issue in patients receiving home continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS). In a multicenter prospective cohort (the Institut de Recherche en Santé Respiratoire des Pays de la Loire [IRSR] sleep cohort) of consecutive OSAHS patients in whom CPAP had been prescribed for at least 90 days, we studied the impact on long-term treatment adherence of socioeconomic factors, patients and disease characteristics prior to CPAP initiation.
  
  
  RESULTS
  Among 1,141 patients in whom CPAP had been prescribed for an average of 504±251 days (range: 91 to 1035), 674 (59%) were adherent with a mean daily use of CPAP≥4 h (mean: 6.42±1.35 h). Stepwise regression analysis identified 4 independent factors of CPAP adherence including apnea-hypopnea index (AHI) (OR: 1.549, 95%CI 1.163 to 2.062 for AHI≥30 vs. AHI<30; p = 0.003), body mass index (BMI) (OR: 1.786, 95%CI 1.131 to 2.822 for BMI≥25 and <30 kg/m(2), p = 0.01; OR: 1.768, 95%CI 1.145-2.731 for BMI≥30 kg/m(2), p = 0.01 vs. BMI<25 kg/m(2)), employment status (OR: 1.414, 95%CI 1.097-1.821 for retired vs. employed; p = 0.007) and marital status (OR: 1.482, 95%CI 1.088-2.019 for married or living as a couple vs. living alone; p = 0.01). Age, gender, Epworth sleepiness scale, depressive syndrome, associated cardiovascular morbidities, educational attainment and occupation category did not influence CPAP adherence.
  
  
  CONCLUSIONS
  Marital status and employment status are independent factors of CPAP adherence in addition to BMI and disease severity. Patients living alone and/or working patients are at greater risk of non-adherence, whereas adherence is higher in married and retired patients. These findings suggest that the social context of daily life should be taken into account in risk screening for CPAP non-adherence. Future interventional studies targeting at-risk patients should be designed to address social motivating factors and work-related barriers to CPAP adherence.
authors.affiliation: LUNAM Université, Angers, France. frgagnadoux@chu-angers.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gagnadoux
authors.forename: Marc
authors.initials: M
authors.lastname: Le Vaillant
authors.forename: François
authors.initials: F
authors.lastname: Goupil
authors.forename: Thierry
authors.initials: T
authors.lastname: Pigeanne
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Chollet
authors.forename: Philippe
authors.initials: P
authors.lastname: Masson
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Humeau
authors.forename: Acya
authors.initials: A
authors.lastname: Bizieux-Thaminy
authors.forename: Nicole
authors.initials: N
authors.lastname: Meslier
mesh_terms: D000368:Aged; D015992:Body Mass Index; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000473:pathology / Q000628:therapy*; D013997:Time Factors