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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.
Sleep & Breathing = Schlaf & Atmung
|November 10, 2025
Summary
Obstructive sleep apnea (OSA) patients with Rapid Eye Movement (REM)-related OSA are less likely to adhere to positive airway pressure (PAP) therapy. Identifying REM-related OSA may help personalize PAP adherence strategies.
Area of Science:
- Sleep Medicine
- Respiratory Medicine
- Pulmonology
Background:
- Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated upper airway collapse during sleep.
- Positive airway pressure (PAP) therapy is the gold standard treatment for moderate to severe OSA.
- Patient adherence to PAP therapy remains a significant challenge, impacting treatment efficacy.
Purpose of the Study:
- To determine polysomnographic predictors of adherence to positive airway pressure (PAP) therapy in adults diagnosed with obstructive sleep apnea (OSA).
- To identify specific sleep characteristics that influence patient compliance with PAP treatment.
Main Methods:
- A retrospective cohort study involving adults with moderate to severe OSA who initiated PAP therapy after a full-night diagnostic polysomnography.
- Exclusion of participants with prior PAP titration studies.
- Logistic regression analysis was employed to identify independent predictors of PAP adherence, defined as using the device ≥4 hours/night on ≥70% of nights.
Main Results:
- Out of 100 patients, 61 achieved the adherence criteria.
- Nonadherent patients showed no significant differences in apnea-hypopnea index, oxygen desaturation index, lowest oxygen saturation, or arousal threshold compared to adherent patients.
- Rapid eye movement (REM)-related OSA was significantly more common in the nonadherent group and emerged as the sole independent predictor of poor adherence (aOR, 2.52; 95% CI, 1.04-6.22; P=.033).
Conclusions:
- Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is identified as the primary independent predictor of poor adherence to positive airway pressure (PAP) therapy.
- Sleep stage-specific phenotyping of OSA may enable tailored strategies to improve patient adherence.
- Further prospective research is recommended to confirm these findings and assess the effectiveness of targeted interventions for enhancing PAP adherence.
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