Association between Self-Efficacy and 1-Year Continuous Positive Airway Pressure Adherence Trajectories: Insight from...

Rationale: Continuous positive airway pressure (CPAP) is the standard of care for obstructive sleep apnea (OSA), but adherence remains a major clinical challenge. Clinical variables are insufficient to fully predict the adherence profile in an individual. Objectives: To determine the association between self-efficacy, determined using the Self-Efficacy Measure for Sleep Apnea (SEMSA)-15 questionnaire, and 1-year CPAP adherence and adherence trajectories in individuals with newly diagnosed OSA. Methods: This prospective, multicenter, observational cohort study was conducted in France; the study started in May 2021, and recruitment finished in December 2022. All participants were adults with OSA referred to a home care provider for CPAP therapy and agreed to the use of their data for research purposes. At baseline, participants completed the SEMSA-15 (to assess self-efficacy), Deprivation in Primary Care Questionnaire (to assess precariousness), and the Health Literacy Questionnaire. CPAP adherence was determined based on objective telemonitoring data and was calculated as mean device use during the first 15 days after therapy initiation or during the 30 days preceding the 90-day and 1-year follow-up. CPAP adherence trajectories were determined using group-based trajectory modeling. Results: A total of 293 individuals were included (70% male; median age 55 yr; median apnea-hypopnea index, 43 events per hour). The median SEMSA-15 total score was significantly higher in adherent versus nonadherent individuals (3.1 vs. 2.8; P < 0.01). After adjustment for confounding variables, the SEMSA-15 score was significantly associated with CPAP adherence at 15 days (odds ratio [OR], 4.08; 95% confidence interval [CI], 2.13-7.79), 90 days (OR, 2.63; 95% CI, 1.39-5.01), and 1 year (OR, 3.14; 95% CI, 1.71-5.79). The SEMSA-15 score was also significantly associated with having a better CPAP adherence trajectory (OR, 2.84; 95% CI, 1.61-5.04). Conclusions: Self-efficacy (based on the SEMSA-15 score) could facilitate the early identification of individuals who are likely to have low adherence and/or be at risk of CPAP therapy termination. Clinical trial registered with www.clinicaltrials.gov (NCT04894175).