Effect of particulate matter on continuous positive airway pressure adherence in obstructive sleep apnea patients

Sleep quality could be affected by air pollution, especially for particulate matter with a diameter of less than 10 microns (PM₁₀) and particulate matter with a diameter of less than 2.5 microns (PM_2.5). However, no direct study demonstrates the relationship and impact of air pollution especially PM₁₀ and PM_2.5 on continuous positive airway pressure (CPAP) adherence. Thus, we aimed to study the correlation between PM₁₀, PM_2.5, and low CPAP adherence in subjects with obstructive sleep apnea (OSA).

We conducted a time-series study from August 2016 to May 2022 in Chiang Mai, Thailand. The data from 2,686 visits of CPAP compliance records from 839 OSA patients' electronic medical records at the Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University, Chiang Mai, Thailand were reviewed. The level of adherence was determined utilizing the provided data. Low CPAP adherence was defined as using CPAP for less than 240 minutes per night or less than 70% of nights (i.e., <5 nights/week) in the previous month. The correlation between the monthly average of PM₁₀ and PM_2.5 and the rate of low CPAP adherence was analyzed using generalized linear mixed model (GLMM) after adjustment for confounding factors.

There was no effect of an increase in PM₁₀ and PM_2.5 on low CPAP adherence [adjusted risk ratio (RR) =0.97; 95% confidence interval (CI): 0.87, 1.09; P value =0.624 and adjusted RR =0.93; 95% CI: 0.81, 1.08; P value =0.350 for PM₁₀ and PM_2.5, respectively].

There was no effect of particulate matter on CPAP adherence in OSA patients.