Polysomnographic parameters predicting positive airway pressure adherence.

PURPOSE: To identify polysomnographic predictors of adherence to positive airway pressure (PAP) therapy in adults with obstructive sleep apnea (OSA).

METHODS

We performed a retrospective cohort study of adults with moderate to severe OSA who underwent full-night diagnostic polysomnography and initiated PAP therapy. Participants with previous PAP titration studies were excluded. Baseline demographic and polysomnographic variables were extracted, and adherence was defined as PAP use ≥ 4 h/night on ≥ 70% of nights. Logistic regression identified factors independently associated with adherence.

RESULTS

Among 100 enrolled patients, 61 met the adherence criteria. Compared with adherent patients, nonadherent patients did not differ in apnea-hypopnea index, oxygen desaturation index, lowest oxygen saturation, or low arousal threshold. Rapid eye movement-related OSA was significantly more prevalent in the nonadherent group and was the only independent predictor of nonadherence (adjusted odds ratio, 2.52; 95% confidence interval, 1.04-6.22; p = 0.033).

CONCLUSIONS

Rapid eye movement-related OSA was the only independent predictor of poor adherence to PAP therapy. Sleep stage-specific phenotyping may therefore assist in personalizing adherence-enhancing strategies. Prospective studies are warranted to validate these findings and evaluate targeted interventions.