Predictors of adherence to continuous positive airway pressure in obstructive sleep apnea and cardiovascular disease

E. Van Ryswyk, C. Anderson, F. Barbe, G. Lorenzi-Filho, K. Loffler, Y.-M. Luo, D. McEvoy, C. L. Chai-Coetzer

Research output: Contribution to conferencePaper


Introduction:Lack of adherence to continuous positive airways pressure (CPAP), the main treatment for obstructive sleep apnea (OSA), is common and affects health outcomes. We aimed to determine the predictors of long‐term adherence to CPAP therapy in participants of the Sleep Apnea and cardioVascular Endpoints (SAVE) trial. Methods:SAVE was an international, randomized, parallel group,open trial of CPAP plus usual care or Usual Care (UC) alone in par-ticipants with moderate‐severe OSA and established CV disease.Before being randomized, participants were required to show an average adherence to sham CPAP treatment of at least 3 hr/night during a one‐week run‐in period. Baseline sociodemographic, health and lifestyle factors, as well as early CPAP side effects and adherence were entered in univariate analyses to identify factors predictive of CPAP adherence at 24 months. Variables withp<0.2 were then included in a multivariate analysis using a linear mixed model with sites as a random effect. Modelling was undertaken using (a)data collected at a 24 month appointment and (b) a calculated24 month adherence value (i.e. a weighted average over 24 months). Results:1,318 of SAVE CPAP participants were included (98%). Independent predictors of greater long‐term adherence were:increased age; greater early CPAP use (during the sham trial and in the first month); very loud snoring; higher percentage of time with oxygen saturation<90%; higher fixed CPAP pressure and regular alcohol use (at baseline). Symptoms of depression predicted poorer adherence, as did residence in China. Discussion:Interventions to improve long‐term adherence toCPAP therapy in OSA patients with co‐occurring cardiovascular dis-ease may be best targeted to those with any of the following char-acteristics: younger; less severe OSA; symptoms of depression; and/or evidence of early poor adherence. Further investigation andefforts to improve CPAP adherence in Chinese patients is alsowarranted.
Original languageEnglish
Number of pages1
Publication statusPublished - Oct 2018
EventSleep Down Under 2018: 30th ASM of Australasian Sleep Association and the Australasian Sleep Technologists Association - Brisbane, Australia
Duration: 17 Oct 201820 Oct 2018


ConferenceSleep Down Under 2018


  • Obstructive sleep apnea
  • SAVE trial
  • Continuous positive airway pressure


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