Characteristics of Patients With More Than 90% Adherence to Automatic Positive Airway Pressure

Background and Objective Among patients suffering from obstructive sleep apnea, there is a group with surprisingly high adherence (≥ 90%) to automatic positive airway pressure (APAP) treatment. This study aims to evaluate the characteristics of these patients.Methods Medical records of 4757 patients, who received APAP prescriptions between July 2018 and December 2019, were reviewed retrospectively. After the exclusion of patients not meeting the study criteria, a total of 103 patients were included in the study, and patients were divided into a very good adherence (VGA; adherence ≥ 90%) group and a poor adherence (PA; adherence < 70%) group, based on nine months of APAP adherence. Patient demographics, medical history, body mass index, and pretreatment polysomnography (PSG) results, as well as APAP therapy adherence-related variables (percentage of total days of APAP usage, and the mean time of APAP usage), the 90th percentile pressure (P90), residual apnea-hypopnea index (AHI), and the type of devices or company managers were compared between the two groups.Results Median age was significantly higher in the VGA group than in the PA group (p = 0.032). The Beck Depression Inventory (BDI) also differed significantly (p = 0.017) between the two groups. There were significant differences in the total sleep time (p = 0.003): 309.04 ± 64.96 min in the VGA group and 345.47 ± 53.06 min in the PA group. Patient sleep efficiency was observed and differed significantly (p = 0.003) 74.46 ± 13.73% in the VGA group and 82.09 ± 10.82% in the PA group. Other parameters, such as a pretreatment PSG and sleep-related questionnaires, did not show significant differences between the two groups. The device-related data at 1, 3, and 9 months were similar, and there were significant differences in the mean usage time (p < 0.001) and the number of days on which the device was used for more than 4 hours a day (p < 0.001) between the two groups. However, the two groups had no significant differences in mean pressure, residual AHI, and the P90.Conclusions The total sleep time, sleep efficiency, and BDI were the main determinants of adherence in patients in the VGA group. To find additional factors which affect adherence, further studies will be needed.