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Adherence to Continuous Positive Airway Pressure Therapy

The Challenge to Effective Treatment

¹ Division of Biobehavioral and Health Sciences, School of Nursing, and ² Center for Sleep and Respiratory Neurobiology, and Division of Sleep Medicine, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ³ Sleep and Circadian Group, Woolcock Institute of Medical Research and National Health and Medical Research Council of Australia Centre for Clinical Research, Excellence for Respiratory and Sleep Medicine, University of Sydney, Sydney, Australia; and ⁴ Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sleep Medicine Consultative Service, St. Vincent's Clinic, Sydney, Australia

Correspondence and requests for reprints should be addressed to Terri E. Weaver, Ph.D., R.N., F.A.A.N., Professor and Chair, Biobehavioral and Health Sciences Division, School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-6096. E-mail: tew{at}nursing.upenn.edu

ABSTRACT

Despite the high efficacy of continuous positive airway pressure (CPAP) to reverse upper airway obstruction in sleep apnea, treatment effectiveness is limited by variable adherence to prescribed therapy. When adherence is defined as greater than 4 hours of nightly use, 46 to 83% of patients with obstructive sleep apnea have been reported to be nonadherent to treatment. Evidence suggests that use of CPAP for longer than 6 hours decreases sleepiness, improves daily functioning, and restores memory to normal levels. The decision to embrace CPAP occurs during the first few days of treatment. Although many strategies in patient interface with CPAP or machine modality are marketed to improve CPAP usage, there are few data to support this. No single factor has been consistently identified as predictive of adherence. Patient perception of symptoms and improvement in sleepiness and daily functioning may be more important in determining patterns of use than physiologic aspects of disease severity. Emerging data suggest that various behavioral interventions may be effective in improving CPAP adherence.

Key Words: sleep apnea • obstructive sleep apnea • compliance • continuous positive airway pressure