Factors associated with noncompliance to treatment with positive airway pressure.

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 chi(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.