The role of confidence, motivation, and social support in positive airway pressure usage in obstructive sleep apnea:...

Despite the well-established benefits of positive airway pressure therapy in obstructive sleep apnea, adoption and persistence rates vary widely. Self-efficacy, motivation, and social support may be important behavioral determinants of positive airway pressure usage, but few studies have examined the role of these factors in real-world populations.

This retrospective analysis examined the association between behavioral survey data and objectively measured positive airway pressure usage data among positive airway pressure therapy users with obstructive sleep apnea. A feature selection process helped to identify key behavioral predictors of positive airway pressure usage, and Firth's logistic regression estimated the association between selected behavioral determinants and short- (90 days) and long-term (360 days) positive airway pressure therapy usage. Regressions controlled for demographic and clinical factors, positive airway pressure device type, and length of therapy use.

A total of 11 228 respondents were included in the 90-day assessment and 3605 were included in the 360-day assessment. Confidence to stay on therapy, identification of a motivator, and involvement of a health care provider were significantly associated with greater odds of both short- and long-term positive airway pressure usage. In males and females, confidence was a significant determinant of greater odds of positive airway pressure usage, but there were gender differences by the type of motivation and the importance of social support.

Confidence, motivation, and healthcare provider involvement may play an important role in achieving both short- and long-term positive airway pressure therapy usage. These insights, alongside the observed differences in behavioral drivers by gender, suggest an opportunity to better understand and tailor positive airway pressure follow-up strategies that leverage behavior change determinants. Statement of Significance Despite the well-established benefit of positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA), patient usage can vary widely. This study is one of the largest real-world investigations of behavioral factors associated with PAP usage, including patient self-efficacy, motivation, and social support. Our findings underscore the importance of confidence, motivational factors, and healthcare provider involvement in achieving short- and long-term PAP therapy usage. Notably, we also identified key gender differences, reinforcing the importance of personalized approaches. Our study provides actionable strategies for PAP adherence interventions, with implications for improving long-term OSA management.