Impact of type D personality on bilevel positive airway pressure compliance and side-effects in sleep apnoea patients.

BACKGROUND

Type D personality, characterised by social inhibition and negative affectivity, has been linked to lower compliance with continuous positive airway pressure (CPAP) and mandibular advancement device treatment, and increased side-effects in obstructive sleep apnoea (OSA) patients. Bilevel positive airway pressure (BiPAP) is often prescribed as an alternative when CPAP is poorly tolerated. However, the influence of type D personality on BiPAP compliance and related side-effects has not been studied. Regarding overall treatment success, mean disease alleviation (MDA) must also be considered.

METHODS

An observational cohort study was conducted in 365 adult patients with OSA or central sleep apnoea who received BiPAP therapy. Type D personality was assessed using the 14-item Type D Scale questionnaire. Data were collected from medical patient records. Compliant users were defined as patients using the device for ≥4 h·night-1. MDA was calculated by multiplying therapeutic efficacy and adjusted compliance. Side-effects were assessed through patient-reported questionnaires.

RESULTS

The cohort included 291 men and 74 women (mean±sd age 56±12 years, median body mass index 32.0 (interquartile range (IQR) 28.7-36.7) kg·m-2, median baseline apnoea-hypopnoea index 44.7 (IQR 28.1-66.7) events·h-1). Type D personality was present in 33% of the cohort. BiPAP compliance was significantly lower in the type D group (median 5.94, IQR 3.29-7.22 h·night-1) compared to the non-type D group (6.27, 4.53-7.63 h·night-1; p=0.023). Six out of 19 studied side-effects were significantly more common in type D patients, with another 12 side-effects showing a trend to higher prevalence.

CONCLUSION

In conclusion, type D personality significantly lowers BiPAP compliance and increases occurrence of side-effects.