Demographics, sleep apnea and positive airway pressure (PAP) treatment-related characteristics associated with PAP adherence: A large retrospective community-based longitudinal observational study.

OBJECTIVE/BACKGROUND:Despite many years of research, multiple factors have inconsistently shown to be associated with positive airway pressure (PAP) adherence. We conducted a retrospective observational study to evaluate the association between selected demographics, obstructive sleep apnea (OSA) - and generally available PAP treatment-related factors with objective PAP therapy adherence. PATIENTS/METHODS:We considered all consented individuals with OSA who purchased a PAP device from a registered vendor (Ottawa, Ontario) between 2011 and 2017 who had usage data available (n = 11,614). PAP adherence was measured objectively as PAP use for at least 4 h on at least 70% of days on treatment. RESULTS:In our cohort, 7147 (61.5%) participants were deemed adherent to PAP over a median of 214 days (IQR: 84-675). The median percentage of days PAP therapy was used was 82% (IQR: 48-97%), and the median number of days PAP therapy was used for greater than 4 h was 95 (IQR: 28-372). In multivariable logistic regression considering all variables available, increased body mass index, older age, and lower minimum SaO2 at baseline sleep study were significantly associated with increased PAP adherence. Individuals who were using PAP longer and with greater adherence during the first month were subsequently more adherent to therapy. We also found a different predictive ability of PAP adherence-related factors by age and sex. CONCLUSIONS:In this retrospective community-based longitudinal observational study, we identified readily available demographics and OSA-related factors associated with PAP adherence. We also confirmed previous findings on age and sex disparities in adherence to PAP.