title: CPAP adherence of patients with obstructive sleep apnea.
abstract: BACKGROUND
  Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up.
  
  
  OBJECTIVE
  We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients.
  
  
  METHODS
  Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed.
  
  
  RESULTS
  Six-hundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Four-hundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred forty-eight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01).
  
  
  CONCLUSIONS
  Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep.
  
  
  CONCLUSIONS
  CPAP/BPAP adherence should be followed with objective monitoring.
authors: Department of Chest Diseases, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey. bsalepci@yahoo.com
authors: Banu
authors: B
authors: Salepci
authors: Benan
authors: B
authors: Caglayan
authors: Nesrin
authors: N
authors: Kiral
authors: Elif Torun
authors: ET
authors: Parmaksiz
authors: Sevda Sener
authors: SS
authors: Comert
authors: Gulsen
authors: G
authors: Sarac
authors: Ali
authors: A
authors: Fidan
authors: Gulten Aktin
authors: GA
authors: Gungor
mesh_terms: D000367:Age Factors; D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology
keywords: CPAP; Epworth Sleepiness Scale; adherence; obstructive sleep apnea