title: Long-term adherence to continuous positive airway pressure therapy in non-sleepy sleep apnea patients.
abstract: OBJECTIVE
  The effectiveness of continuous positive airway pressure (CPAP) therapy greatly depends on consistent use. However, data regarding adherence in non-sleepy obstructive sleep apnea (OSA) patients are scarce. The aim of this study was to assess long-term adherence and predictors of CPAP compliance in a large sample of non-sleepy OSA patients.
  
  
  METHODS
  We conducted a prospective, multicenter study comprising 357 non-sleepy patients (Epworth Sleepiness Scale score <11) with moderate-to-severe OSA (apnea-hypopnea index [AHI] of ≥20) who began CPAP therapy between May 2004 and May 2006; follow-up ended in May 2009. Non-compliance was scored as CPAP dropout or average cumulative CPAP use of <4 hours per night. Multivariate Cox regression analysis was performed to identify independent predictors of poor CPAP adherence.
  
  
  RESULTS
  Patients were followed up for a median of four years (interquartile range [IQR] = 3.0-4.4). At the end of the study period, 230 patients (64.4%) fulfilled the criteria for good CPAP compliance, whereas 127 patients (35.6%) were considered non-compliant. The median CPAP use was five hours per night (interquartile range = 2.18-6.25). Multivariate analysis showed that interactions between the AHI and the percentage of nighttime spent with an O2 saturation of <90% (TC90) (p = 0.010) and between the AHI and hypertension at baseline (p = 0.029) predicted long-term compliance with CPAP.
  
  
  CONCLUSIONS
  This study demonstrates that CPAP treatment is feasible in non-sleepy, moderate-to-severe OSA patients. Good CPAP adherence was predicted by greater OSA severity as measured by both the AHI and TC90 and by the presence of hypertension at baseline in patients with higher AHI levels.
authors: Respiratory Department, Hospital Universitario de Valme, Seville, Spain.
authors: Francisco
authors: F
authors: Campos-Rodriguez
authors: Department of Statistics, IRB Lleida, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors: Montserrat
authors: M
authors: Martinez-Alonso
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Catalonia, Spain.
authors: Manuel
authors: M
authors: Sanchez-de-la-Torre
authors: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Catalonia, Spain. Electronic address: febarbe.lleida.ics@gencat.cat.
authors: Ferran
authors: F
authors: Barbe
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
keywords: Adherence; Continuous positive airway pressure; Excessive daytime sleepiness; Obstructive sleep apnea