Study objectives: Despite the efficacy of positive airway pressure (PAP) for the treatment of obstructive sleep apnea (OSA), adherence remains challenging and negatively impacts assessments of effectiveness. It is unclear if low adherence is due to intolerance of PAP, or if this reflects overall adherence with medical therapy. We sought to correlate PAP use with medication adherence to determine if poor adherence with PAP was specific to this treatment or represented global compliance with medical therapy.
Methods: 600 consecutive OSA patients treated with PAP. Objective measures of PAP use were correlated with medication adherence. We included all chronically used medications, defined as medications used daily for at least ninety days prior to PAP initiation. Medication use was verified using an electronic health record. PAP adherence ("regular use") was defined as PAP use for ≥4 hours/night on ≥70% of nights. Medication adherence was defined as >70% of pills taken as prescribed.
Results: Complete records were available for 566 patients, 361 (63.8%) utilized chronic medications. The cohort was primarily men (90.3%, age 44.6±10.2 years), with moderate OSA (AHI 18.1±13.9 events/h). In patients on chronic medications, PAP was used 55.8% of nights and 37.7% were regular users. Patients who were adherent with medications used PAP more hours/night (5.4 vs. 4.6, p<0.001) and were more likely to have regular PAP use compared to those non-adherent with medications (p=0.04).
Conclusions: Adherence with PAP correlated with adherence to chronic medications. Low PAP adherence may reflect an individual's global adherence to medical care. This association may lead to better identification of patients who benefit from targeted therapy to improve overall healthcare adherence.
Keywords: obstructive sleep apnea; positive airway pressure; treatment compliance.
© 2024 American Academy of Sleep Medicine.