A new characterization of adherence patterns to auto-adjusting positive airway pressure in severe obstructive sleep apnea syndrome: clinical and psychological determinants

The aim of this study was to examine the joint role of demographic, clinical, psychological and family coping variables as predictors of adherence patterns to auto-adjusting positive airway pressure (APAP). A total of 153 patients diagnosed with obstructive sleep apnea syndrome (OSAS) were assessed during a 6-months APAP treatment period. All patients underwent psychological evaluation prior to treatment (T1) and 1 to 3 months (T2) and 4 to 6 months (T3) post-APAP treatment. Of these, 107 patients maintained a stable adherence pattern to APAP during the treatment period. Forty-seven percent were poorly adherent, 27 % were moderately adherent and 26 % were optimally adherent OSAS patients. Several factors distinguished the three adherence patterns and some of these emerged as the main predictors. In T1, the first model included age, apnea-hypopnea index, outcome expectations and coping spiritual support, as main predictors to distinguish adherence patterns. In T2 and T3, two models emerged adjusted to the variables of model 1 that included leakage, self-efficacy, mobilizing family acquire/accept support and reframing in model 2 and self-efficacy in model 3. Generally, the areas under the ROC curve, presented a good discrimination. Findings revealed an integrative heuristic model that accounted for the joint influence of demographic, clinical, psychological, and family coping factors on poor, moderate, and optimal adherence patterns.