Trends in CPAP adherence over twenty years of data collection: a flattened curve

Abstract

BackgroundObstructive sleep apnea (OSA) is a common disorder, and continuous airway positive pressure (CPAP) is considered to be the gold standard of therapy. CPAP however is known to have problems with adherence, with many patients eventually abandoning the device. The purpose of this paper is to assess secular trends in CPAP adherence over the long term to see if there have been meaningful improvements in adherence in light of the multiple interventions proposed to do so.MethodsA comprehensive systematic literature review was conducted using the Medline-Ovid, Embase, and Pubmed databases, searching for data regarding CPAP adherence over a twenty year timeframe (1994–2015). Data was assessed for quality and then extracted. The main outcome measure was reported CPAP non-adherence. Secondary outcomes included changes in CPAP non-adherence when comparing short versus long-term, and changes in terms of behavioral counseling.ResultsEighty-two papers met study inclusion/exclusion criteria. The overall CPAP non-adherence rate based on a 7-h/night sleep time that was reported in studies conducted over the twenty year time frame was 34.1 %. There was no significant improvement over the time frame. Behavioral intervention improved adherence rates by ~1 h per night on average.ConclusionsThe rate of CPAP adherence remains persistently low over twenty years worth of reported data. No clinically significant improvement in CPAP adherence was seen even in recent years despite efforts toward behavioral intervention and patient coaching. This low rate of adherence is problematic, and calls into question the concept of CPAP as gold-standard of therapy for OSA.

Upper airway stimulation therapy and sleep architecture in patients with obstructive sleep apnea

“…These studies also based their results on consistent use of CPAP, with higher than average compliance rates, making their findings difficult to reproduce. Although the literature suggests that optimal CPAP use is between 6 to 7 hours per night, long‐term longitudinal data have actually defined CPAP compliance as low as 4.6 hours/night with 30% to 40% noncompliance rates . Our compliance rates were 49.1 hours/week, averaging to a nightly use of about 7 hours.…”

Effects of continuous positive airway pressure on neurocognitive and neuropsychiatric function in obstructive sleep apnea

“…Acceptance and adherence are important conditions for good CPAP compliance (Rotenberg et al, ). Adherent patients are usually defined as those who use CPAP for an average of 4 hr per night on 70% of nights (Rotenberg et al, ).…”

Technical Developments and Clinical Use of Telemedicine in Sleep Medicine

“…It has also been demonstrated that early adherence (at one week or one month) is associated with better adherence at six months [20,21]. In a recent literature review, the long-term adherence rate has been estimated at 66% [22]. Factors such as psychological barriers, social concerns, side effects, disease characteristics and first CPAP exposure can affect treatment acceptance and adherence [23] and as many as 5 to 50% of patients refuse treatment or reject it rapidly after initiation [24].…”