Adherence to positive airway pressure therapy

Abstract

The purpose of this review is to discuss the nature of adherence to continuous positive airway pressure (CPAP), identify measurement modalities, consider factors that have been identified in the literature associated with nonadherence and present interventions that may promote use. Patient characteristics associated with CPAP adherence include self-reported daytime sleepiness, level of disease severity, nasal resistance and perception of symptomatic benefit. Heated humidification and flexible pressure also promote use. Feelings of claustrophobia affect adherence in a small proportion of patients. Adherence was better with nasal mask than nasal pillows and full face mask and equal to oral interface. Patients who employed an active coping style and those with perceived self-efficacy, especially following exposure to treatment, had higher levels of adherence. A videotape targeted to improve self-efficacy and other interventions to enhance cognitions related to CPAP has generated greater use. Intensive support utilizing several days of titration, education and home visits also improves adherence. Adherence to CPAP treatment is an important clinical issue that needs to be routinely assessed and addressed. Frequent patient contact to troubleshoot problems will contribute to adherence. Further study is needed to identify factors that affect adherence and cost-effective interventions.