Analysis of positive airway pressure adherence in 102,564 patients with obstructive sleep apnea in Korea

Positive airway pressure (PAP) therapy is the most effective treatment for obstructive sleep apnea (OSA), yet long-term adherence remains a challenge. This study aimed to assess nationwide long-term PAP adherence and associated factors in Korea using National Health Insurance Service (NHIS) data.

We analyzed National Health Insurance Service (NHIS) claims data from 102,564 adults diagnosed with obstructive sleep apnea (OSA) based on polysomnography results and prescribed positive airway pressure (PAP) therapy between July 2018 and December 2021. Adherence was defined according to insurance criteria as follows: during the compliance phase, usage of ≥4 h per night on at least 21 days within any 30-day period; thereafter, an average usage of ≥2 h per day in each subsequent 3-month period. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to assess adherence patterns and identify associated predictors.

Only 12.2 % of patients remained adherent over the follow-up period. Better adherence was associated with younger age (especially 20-29 years), female sex, and auto-titrating devices. Higher body mass index (≥30 kg/m²), older age (especially 40-49 years), and use of continuous PAP were linked to poorer adherence. Prescriptions from neurologists and psychiatrists were associated with slightly better adherence than those from otolaryngologists. Economic status, residential region, disability status, and mask type were not significant predictors.

Despite Korea's universal health coverage and strict adherence monitoring, long-term PAP adherence was unexpectedly low. Continued efforts are warranted to improve PAP adherence, particularly through the implementation of more flexible maintenance requirements and the introduction of positive incentives to encourage sustained use.