The impact of PAP therapy first impression on short-term treatment adherence

Positive airway pressure (PAP) treatment for obstructive sleep apnea syndrome (OSAS) is often burdened by lower adherence rates. Patients' perception and acceptance of PAP therapy play a crucial role in achieving acceptable adherence.

We conducted a prospective cohort study to assess patients' initial impressions of PAP therapy using a six-item questionnaire. The questionnaire evaluated CPAP tolerance, interface comfort, titration pressure, likelihood of CPAP use, expected health benefits, and overall attitude toward PAP therapy. Patients underwent a baseline awake PAP therapy trial (T0) followed by titration with an automatic device (APAP). After one month of titration, a fixed CPAP value was set (T1). Follow-ups occurred at 1 (T2), 3 (T3), and 6 (T4) months after the start of treatment. Adherence to PAP therapy was considered sufficient if the mean device usage was ≥ 4 h/night at T4.

After six months, 77% of the enrolled patients achieved high PAP treatment adherence. Questionnaire scores generally improved from T0 to T4, particularly in CPAP tolerance, likelihood of treatment adherence, expected health benefits, and overall judgment of PAP therapy. Time-to-event analysis revealed that higher baseline scores in titration pressure comfort, likelihood of CPAP adherence, and overall judgment of PAP therapy were significantly associated with higher adherence likelihood.

Patients' first judgement on PAP therapy could significantly influence short-term adherence. Early identification and management of patients' complaints and discomforts could improve adherence rates and PAP perception over time.