title: Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study.
abstract: OBJECTIVE
  To determine the clinical variables that best predict long- term continuous positive airway pressure (CPAP) adherence among patients with cardiovascular disease who have obstructive sleep apnea (OSA).
  
  
  METHODS
  12-mo prospective within-trial observational study.
  
  
  METHODS
  Centers in China, Australia, and New Zealand participating in the Sleep Apnea cardioVascular Endpoints (SAVE) study.
  
  
  METHODS
  There were 275 patients age 45-70 y with cardiovascular disease (i.e., previously documented transient ischemic attack, stroke, or coronary artery disease) and OSA (4% oxygen desaturation index (ODI) > 12) who were randomized into the CPAP arm of the SAVE trial prior to July 1, 2010.
  
  
  METHODS
  Age, sex, country of residence, type of cardiovascular disease, baseline ODI, severity of sleepiness, and Hospital Anxiety and Depression Scale (HADS) scores plus CPAP side effects and adherence at 1 mo were entered in univariate analyses in an attempt to identify factors predictive of CPAP adherence at 12 mo. Variables with P < 0.2 were then included in a multivariate analysis using a linear mixed model with sites as a random effect and 12-mo CPAP use as the dependent outcome variable.
  
  
  RESULTS
  CPAP adherence at 1, 6, and 12 mo was (mean ± standard deviation) 4.4 ± 2.0, 3.8 ± 2.3, and 3.3 ± 2.4 h/night, respectively. CPAP use at 1 mo (effect estimate ± standard error, 0.65 ± 0.07 per h increase, P < 0.001) and side effects at 1 mo (-0.24 ± 0.092 per additional side effect, P = 0.009) were the only independent predictors of 12- mo CPAP adherence.
  
  
  CONCLUSIONS
  Continuous positive airway pressure use in patients with coexisting cardiovascular disease and moderate to severe obstructive sleep apnea decreases significantly over 12 months. This decline can be predicted by early patient experiences with continuous positive airway pressure (i.e., adherence and side effects at 1 month), raising the possibility that intensive early interventions could improve long-term continuous positive airway pressure compliance in this patient population.
  Clinical Trials, http://www.clinicaltrials.gov, NCT00738179.
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Australia ; Flinders University, Adelaide, Australia.
authors.forename: Ching Li
authors.initials: CL
authors.lastname: Chai-Coetzer
authors.forename: Yuan-Ming
authors.initials: YM
authors.lastname: Luo
authors.forename: Nick A
authors.initials: NA
authors.lastname: Antic
authors.forename: Xi-Long
authors.initials: XL
authors.lastname: Zhang
authors.forename: Bao-Yuan
authors.initials: BY
authors.lastname: Chen
authors.forename: Quan-Ying
authors.initials: QY
authors.lastname: He
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.forename: Shao-Guang
authors.initials: SG
authors.lastname: Huang
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
authors.forename: Nan-Shan
authors.initials: NS
authors.lastname: Zhong
authors.forename: R Doug
authors.initials: RD
authors.lastname: McEvoy
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D002318:Cardiovascular Diseases / Q000150:complications; D045422:Continuous Positive Airway Pressure / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000523:psychology / Q000628:therapy; D016032:Randomized Controlled Trials as Topic
keywords: Cardiovascular disease; compliance; continuous positive airway pressure; obstructive sleep apnea