Unveiling the complexity: predicting long-term CPAP adherence among patients with moderate to severe OSA undergoing...

The study aims to assess the effect of a continuous positive airway pressure (CPAP) trial before titration on acceptability, CPAP pressures and sleep efficiency, and to predict long-term adherence to CPAP titration. The study assesses the treatment response and determines the optimum pressures.

Prospective, randomised, single-centre, Cohort Study conducted in a tertiary care hospital in India. Patients of Indian origin with moderate to severe OSA diagnosed by level 1 polysomnography in our hospital were included in the study. Patients with haemodynamic instability and psychiatric disorders, and those who refused to consent to the study, were excluded from the study. Patients randomised into two groups were assessed for acceptability to CPAP following the titration study, and other parameters like sleep efficiency and mean CPAP pressures were noted. Anxiety is assessed using the Beck Anxiety Inventory at baseline and at three months. Compliance with CPAP is evaluated at three months using a proforma with the data obtained from the CPAP apparatus.

The acceptability of CPAP was better in the interval group. The results showed a statistically significant negative correlation between acceptability and average use of CPAP (r=-0.382, p-value < 0.001) and with the number of nights CPAP was used last month for > 4 h (r=-0.514, p-value < 0.001). The sleep efficiency at titration was better in the interval group.

A trial of CPAP before a titration study could improve acceptability, lower the CPAP pressures and improve long-term adherence in patients with moderate to severe OSA.