title: Depression may reduce adherence during CPAP titration trial.
abstract: OBJECTIVE
  Depression is a risk factor for medication non-compliance. We aimed to identify if depression is associated with poorer adherence during home-based autotitrating continuous positive airway pressure (autoPAP) titration.
  
  
  METHODS
  Mixed retrospective-observational study.
  
  
  METHODS
  Academic center.
  
  
  METHODS
  Two-hundred forty continuous positive airway pressure-naïve obstructive sleep apnea (OSA) patients.
  
  
  METHODS
  Patients underwent approximately 1 week of home-based autoPAP titration with adherence data downloaded from the device. Electronic hospital records were reviewed in a consecutive manner for inclusion. Three areas of potential predictors were examined: (i) demographics and clinical factors, (ii) disease severity, and (iii) device-related variables. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Scores on the subscales were categorized as normal or clinical diagnoses of depression (≥ 8) and anxiety (≥ 11). The primary outcome variable was the mean hours of autoPAP used per night.
  
  
  RESULTS
  Patients were diagnosed with OSA by either attended polysomnography (n = 73, AHI 25.5[15.1-41.5]) or unattended home oximetry (n = 167, ODI3 34.0[22.4-57.4]) and had home-based autoPAP titration over 6.2 ± 1.2 nights. Mean autoPAP use was 4.5 ± 2.4 hours per night. Multiple linear regression analysis revealed that depression and lower 95(th) percentile pressures significantly predicted lesser hours of autoPAP use (R(2) = 0.19, p < 0.001). Significantly milder OSA in those requiring lower pressures may have confounded the relationship between 95(th) percentile pressure and autoPAP use.
  
  
  CONCLUSIONS
  Depression was independently associated with poorer adherence during home-based autoPAP titration. Depression may be a potential target for clinicians and future research aimed at enhancing adherence to autoPAP therapy.
authors.affiliation: Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia.
authors.forename: Mandy
authors.initials: M
authors.lastname: Law
authors.affiliation: Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Naughton
authors.affiliation: Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Ho
authors.affiliation: Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia.
authors.forename: Teanau
authors.initials: T
authors.lastname: Roebuck
authors.affiliation: Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia.
authors.forename: Eli
authors.initials: E
authors.lastname: Dabscheck
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Obstructive sleep apnea; adherence; continuous positive airway pressure; depression