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Factors Associated With Noncompliance to Treatment With Positive Airway Pressure
Ho-Sheng Lin, MD;
Abhishek S. Prasad, MD;
Chuan-Ju G. Pan, BS;
James A. Rowley, MD
Arch Otolaryngol Head Neck Surg. 2007;133(1):69-72.
Objective To identify risk factors that may predispose patients with a diagnosis of obstructive sleep apnea (OSA) to fail treatment with positive airway pressure (PAP) owing to noncompliance.
Design Retrospective medical chart review.
Setting Academic tertiary care center.
Patients Patients who underwent polysomnography during 2 periods: from March 1999 to July 2001 and from March 2003 to December 2003.
Main Outcome Measures Of the 949 patients identified, only 131 patients had complete medical and follow-up records that were adequate for analysis of compliance. Compliance was defined as using PAP for at least 4 hours per night on 70% of the nights monitored. We used  2 and logistic regression analyses to assess correlations among PAP compliance and various patient variables as well as among sleep and titration study parameters.
Results Of the 131 patients analyzed, 48 patients (37%) were noncompliant with PAP therapy. A statistically significant correlation was found between a low apnea-hypopnea index (AHI) and PAP noncompliance (P = .004).
Conclusions In this study, a low AHI was identified as a risk factor for noncompliance with PAP treatment. Therefore, patients with OSA and with a low AHI may warrant closer follow-up to allow early identification of PAP treatment failure owing to noncompliance and to allow timely institution of other treatment modalities, such as surgery.
Author Affiliations: Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Mich (Dr Lin); and Departments of Otolaryngology–Head and Neck Surgery (Drs Lin and Prasad and Ms Pan) and Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Rowley), Wayne State University School of Medicine, Detroit.
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