Preoperative adherence to continuous positive airway pressure among obstructive sleep apnea patients

Obstructive Sleep Apnea (OSA) increases the perioperative risk of complications. Chronic use of Continuous Positive Airway Pressure (CPAP) by patients decreases the importance of comorbidities caused by the OSA. However, many patients do not adhere to the treatment. Given the postoperative complications, it is important for the anesthesiologist to identify non-adherent patients. This prospective study was designed to identify factors that would predict patient adherence.

Ninety patients who were treated by CPAP for more than one year were recruited. Among them, and based on objective criteria such as length of use of CPAP during the night, 75 were considered as being adherent to CPAP, while the other 15 were not. Sixty-two potential causes of non-adherence were investigated (some have not been tested before), and further divided into five categories. Those categories included cultural, intellectual, or economic factors, OSA comorbidities, patient belief about health, ENT-related problems, and pathophysiological features estimating the degree of improvement afforded by CPAP introduction.

Multivariate binary logistic regression analysis identified one criterion of non-adherence to treatment, namely the feeling of breathlessness, and three criteria of adherence, namely awareness of the risk of complications, awareness of treatment efficacy, and feeling of being less tired with CPAP therapy.

These four new criteria should preoperatively be sought, in order to detect non-adherent patients more efficiently.