Improvement of sleep parameters by titration polysomnography could predict adherence to positive airway pressure therapy in obstructive sleep apnea.

STUDY OBJECTIVES: Poor adherence to continuous positive airway pressure (CPAP) has been a critical issue in treating obstructive sleep apnea (OSA). Since long-term CPAP adherence may be established shortly after treatment begins, early intervention is essential. This study aimed to identify the potential factors affecting CPAP therapy adherence during diagnostic polysomnography (dPSG) and auto CPAP titration polysomnography (tPSG).

METHODS: This retrospective observational study included 463 patients with OSA who underwent consecutive dPSG and tPSG. We recorded their demographic, anthropometric, and lifestyle factors and obtained subjective comments regarding their sleep status following both polysomnography evaluations. CPAP adherence was evaluated following three months of treatment.

RESULTS: A total of 312 patients (67.4%) fulfilled the criteria for good adherence. Each patient's CPAP adherence was categorized as "poor" (<4 h/night or <70% of nights), "good" (≥4 h/night and ≥70% of nights), and "excellent" (≥6 h/night and ≥80% of nights). There were no significant differences in SpO2 and apnea-hypopnea Index (AHI) during dPSG among three groups. The polysomnographic evaluations indicated that patients with better adherence displayed more significant improvements in sleep parameters, including AHI, sleep efficacy, sleep latency, and sleep architecture, which were correlated with an improvement in the subjective sleep quality.

CONCLUSIONS: Polysomnographic evaluations enabled CPAP adherence prediction and a comparison of the subjective sleep quality with and without CPAP; CPAP adherence led to improvements in polysomnographic parameters. Our findings suggest that tPSG and subjective sleep improvement with CPAP could be used for adherence prediction in clinical practice.