The association between difficulty using positive airway pressure equipment and adherence to therapy: a pilot study

Little is known about the ease of use of positive airway pressure (PAP) equipment and whether PAP equipment usability is associated with adherence. This pilot project aims to determine whether perceived difficulty with the mechanics of using PAP equipment is associated with nonadherence.

Within a larger study of insomnia treatments, we screened (via telephone interview) 148 adults for sleep apnea/prior PAP use and asked them to describe the degree of difficulty putting on their PAP mask, adjusting their mask straps, turning dials/pushing PAP machine buttons, disconnecting tubing, and removing the machine's water chamber (five items; five-point Likert-like scale) and to report their PAP use (0 versus ≥1 days in the past week).

Mean age of participants was 66.7 years (SD 7.0). Thirty respondents (20.3 %) reported at least "some difficulty" with at least one aspect of PAP equipment usability, and 15 respondents (10.1 %) reported at least "quite a lot of difficulty" with one or more aspects of PAP equipment usability. Of the participants, 43.9 % reported not using PAP equipment at all during the past week. Participants (73.3 %) with substantial PAP equipment difficulty (at least quite a lot of difficulty) versus 40.6 % without substantial difficulty reported zero nights of PAP use in the past week (chi-square 5.86, p = .015).

Difficulty using PAP equipment is associated with PAP nonadherence. Studies are needed to confirm these findings and to identify determinants of poor usability. If findings are confirmed, strategies could be developed to improve PAP usability, which may improve adherence.