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Published on: December 6, 2016
Polysomnographic parameters predicting positive airway pressure adherence
Nattarin Nilrat1,2, Wish Banhiran1, Phawin Keskool1
1Department of Otorhinolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Purpose:
To identify polysomnographic predictors of adherence to positive airway pressure (PAP) therapy in adults with obstructive sleep apnea (OSA).
Methods:
We performed a retrospective cohort study of adults with moderate to severe OSA who underwent full-night diagnostic polysomnography and initiated PAP therapy. Participants with previous PAP titration studies were excluded. Baseline demographic and polysomnographic variables were extracted, and adherence was defined as PAP use ≥ 4 h/night on ≥ 70% of nights. Logistic regression identified factors independently associated with adherence.
Results:
Among 100 enrolled patients, 61 met the adherence criteria. Compared with adherent patients, nonadherent patients did not differ in apnea-hypopnea index, oxygen desaturation index, lowest oxygen saturation, or low arousal threshold. Rapid eye movement-related OSA was significantly more prevalent in the nonadherent group and was the only independent predictor of nonadherence (adjusted odds ratio, 2.52; 95% confidence interval, 1.04-6.22; p = 0.033).
Conclusions:
Rapid eye movement-related OSA was the only independent predictor of poor adherence to PAP therapy. Sleep stage-specific phenotyping may therefore assist in personalizing adherence-enhancing strategies. Prospective studies are warranted to validate these findings and evaluate targeted interventions.
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