Family History of Successful CPAP Treatment is Associated with Improved CPAP Compliance

Abstract

Background: Non-compliance with continuous positive airway pressure (CPAP) is a significant problem in the treatment of obstructive sleep apnea (OSA). When compliance is defined as an average CPAP use >4 hours/night, 46%-83% of patients are non-compliant. Poor compliance leaves undertreated patients at increased risk for cardiovascular and neurocognitive sequelae of OSA. Factors known to affect CPAP compliance include disease severity, perceived symptomatic benefit, and intensive and early support through the sleep clinic. Objectives: The objective of this study was to assess the effect of a family history of successful CPAP treatment on CPAP compliance. Methods: An anonymous survey of 410 adult patients attending CPAP follow-up clinic at a tertiary medical center was conducted between March 2010 and February 2011. Patterns of CPAP use were assessed. Compliance was defined as an average CPAP use >4 hours/night. Subjects were also surveyed regarding the presence of first degree relatives with a diagnosis of OSA, their use of CPAP, whether they described their CPAP as “helpful” and whether or not they “liked” using their CPAP. Results: Thirty-eight percent of the patients surveyed (n=157) had a family member who also had a diagnosis of OSA and used CPAP. Of those with a family history of CPAP use, 92% of compliant patients had a family member who described their CPAP as “helpful” vs. 71% of non-compliant patients (p=0.002). Logistic regression analysis to predict compliance vs. non-compliance, controlling for age, gender, ethnicity, and a diagnosis of co-morbid hypertension or diabetes showed that having a family member who found CPAP “helpful” was associated with an odds ratio for compliance of 4.70 (95% CI 1.99-11.07, p value <0.001). In addition, 72% of compliant vs. 60% of noncompliant patients had a family history of CPAP use with a family member who “liked” their CPAP (p=0.3). Conclusion: CPAP non-compliance is a complex multifactorial clinical problem. This study shows that familial social support, in the form of modeling CPAP use and self-described helpfulness of CPAP therapy, is associated with CPAP compliance.