The relationship between positive airway pressure tolerance and adherence: defining a new metric.

Study Objectives: Positive airway pressure (PAP) therapy adherence rates range from 30% to 60%, yet adherent patients may still express dissatisfaction with treatment. The identification of factors affecting PAP tolerance could provide insight into its impact on adherence.

Methods: Patients with obstructive sleep apnea presenting for first follow-up visit after newly initiating PAP therapy were given a 10-question PAP tolerance survey encompassing domains of psychosocial perception, practical issues, and side effects, utilizing 10-point visual analog scales. Relationships between adherence data, tolerance scores, and patient variables (demographics, sleep-related factors, comorbidities, usage data) were explored via 2-tailed tests, multivariable regression analysis, and recursive partitioning regression trees with a significance level of ≤ .05.

Results: For 105 patients, tolerance scores were higher in patients considered adherent to therapy ( = .033), as were scores for individual survey questions addressing the ability to fall asleep ( = .013) and sleep through the night ( = .020). Depression positively ( = .006) and insomnia medication use negatively ( = .010) predicted tolerance score. Data-driven tolerance score cutoffs were identified to correlate with PAP adherence, with higher tolerance scores correlating with greater adherence rates.

Conclusions: PAP tolerance may play an important role in therapy adherence. Tolerance can be statistically defined and categorized based on prior adherence data. Its utility as a predictive tool in assessing future adherence is warranted.

Citation: Tekumalla S, Plawecki A, Kaffenberger T, et al. The relationship between positive airway pressure tolerance and adherence: defining a new metric. . 2024;20(7):1033-1038.