AP Model: A Simple Tool to Predict Poor Long-Term PAP Adherence in Obstructive Sleep Apnea

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Clinical Research

Background:

• Positive airway pressure (PAP) therapy is a cornerstone for managing obstructive sleep apnea (OSA).
• Predicting long-term PAP adherence remains challenging, particularly in diverse populations.
• Understanding adherence predictors is crucial for optimizing treatment outcomes in OSA management.

Purpose of the Study:

• To identify clinical and polysomnographic factors associated with poor long-term PAP adherence in a Southeast Asian OSA cohort.
• To develop a practical risk prediction model for PAP non-adherence.
• To improve PAP compliance through targeted interventions based on identified predictors.

Main Methods:

• Retrospective cohort study involving adult OSA patients (18-65 years) prescribed PAP therapy.
• Objective adherence data collected via PAP device downloads over 12 months.
• Logistic regression analysis to identify independent predictors of poor long-term adherence (defined as <4 hours/night on <70% of nights).

Main Results:

• Out of 343 enrolled patients, 253 had 12-month follow-up data; 47.8% achieved good adherence.
• Younger age (<50 years) and poor short-term adherence were significant independent predictors of poor long-term PAP adherence.
• The developed "AP" model (Age and Poor early adherence) demonstrated good predictive performance (AUC=0.73) with high specificity (94%).

Conclusions:

• This study provides valuable insights into PAP adherence predictors in a Southeast Asian population, distinct from Western data.
• The simple "AP" model offers a pragmatic tool for identifying at-risk patients, applicable even in resource-limited settings.
• Further multicenter validation across Southeast Asia is recommended to enhance the model's generalizability and incorporate modifiable adherence factors.