CPAP Nonadherence Issues in a Small Sample of Men With Obstructive Sleep Apnea

Introduction: Continuous positive airway pressure (CPAP) adherence is poor among those with obstructive sleep apnea (OSA), especially middle-aged and older men. Untreated or poorly-treated OSA potentially leads to acute and chronic sequelae, posing increased morbidity and mortality risks among those with OSA. The purpose of this study was to identify CPAP adherence issues among middle-aged and older men with OSA. Identifying CPAP use issues may assist both practitioners and researchers in understanding treatment needs and developing interventions that will promote improved CPAP adherence and, subsequently, patient quality of life.

Method: After institutional review board approval, participants were recruited from medical offices and community contacts (N=4). Face-to-face and telephone interviews were conducted to address CPAP-use related issues. Demographic data were analyzed using SPSS 22. Themes were identified independently by two reviewers using van Manen’s hermeneutic phenomenological reflection approach.

Results: Participants reported many issues affecting their nightly CPAP use, including lack of understanding of the disease and its risks at the time of diagnosis, discomfort from the CPAP pressure, and mask problems. Five themes emerged, highlighting CPAP use issues: Struggles and frustrations, the CPAP machine and the masks, disruptions in routine and body image, impetus for continuing use, and wishing for alternative treatments.

Discussion: The authors recommend practice changes and research initiatives to address CPAP use. Early education and support are essential, especially to assist patients in understanding OSA-associated risks and need for use, perceiving CPAP as a positive experience, and developing a habit of nightly wear. Problem solving machine and mask issues early in treatment, encouraging continued support from the bed partner/significant other and healthcare providers, and providing education of OSA-CPAP numbers with a monthly report card are recommended intervention components that may facilitate improved CPAP use and subsequent adherence. Further research is needed to test these interventions and their impact on short- and long-term CPAP use.