title: Impact of Randomization, Clinic Visits, and Medical and Psychiatric Cormorbidities on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea.
abstract: OBJECTIVE
  To evaluate factors associated with continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES) cohort.
  
  
  METHODS
  The data from a prospective 6-mo multicenter randomized controlled trial with 558 subjects randomized to active CPAP and 547 to sham CPAP were analyzed to assess adherence to CPAP during first 2 mo (early period) and during months 5-6 (late period).
  
  
  RESULTS
  Participants randomized to active CPAP had higher hours of nightly adherence compared to the sham CPAP group at both 2 (4.9 ± 2.0 h versus 4.07 ± 2.14 h, p < 0.001) and 6 mo (4.70 ± 2.08 h versus 3.41 ± 2.19 h, p < 0.001). Those assigned to sham CPAP were more likely to correctly identify their treatment group (70.0% versus 55.2%, p < 0.001). Irrespective of treatment group assignment, those who believed they were receiving active CPAP had higher hours of adherence than those who thought they were in the sham CPAP group at both 2 mo (4.91 ± 2.01 versus 4.17 ± 2.17, p < 0.001) and 6 mo (4.65 ± 2.10 versus 3.65 ± 2.22, p < 0.001). Among those randomized to active CPAP, older age was significantly related to CPAP use > 4 h per night. Presence of cardiovascular disorders was associated with higher hours of CPAP use, whereas presence of anxiety was associated with a trend toward lower hours of CPAP use. Presence of nasal congestion was associated with a decrease in mean daily CPAP use between the early and the late adherence period. The adherence during the week prior to a clinic visit was higher than the average adherence during the 2-mo period prior to the visit.
  
  
  CONCLUSIONS
  Randomization to active therapy, belief that one is in the active treatment group, older age, and possibly presence of cardiovascular disorders are positively linked to CPAP adherence. Nasal congestion and anxiety are negatively associated with CPAP adherence. CPAP nightly usage increases as clinic visits approach.
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Budhiraja
authors.affiliation: Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Nichols
authors.affiliation: Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, MO.
authors.forename: James K
authors.initials: JK
authors.lastname: Walsh
authors.affiliation: Providence St. Mary Medical Center, Walla Walla, Washington.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Simon
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA.|VA Boston Healthcare System, Boston, MA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gottlieb
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA.|Arizona Respiratory Center, University of Arizona, Tucson, AZ.
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
mesh_terms: D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000150:complications*; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009296:Nasal Cavity / Q000503:physiopathology; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011897:Random Allocation; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy
keywords: CPAP; adherence; age; comorbid; compliance; continuous positive airway pressure; medical disorders; obstructive sleep apnea; psychiatric disorders; race; sex; sleep disordered breathing