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. 2024 Jul 1;20(7):1087-1092.
doi: 10.5664/jcsm.11092.

Correlation between positive airway pressure and medication adherence: the healthy user effect

Matthew J Lettieri  1 , Whittney A Warren  2 , Robert J Walter  2   3 , Christopher J Lettieri  3
Affiliations

Correlation between positive airway pressure and medication adherence: the healthy user effect

Matthew J Lettieri et al. J Clin Sleep Med. .

Abstract

Study objectives: Despite the efficacy of positive airway pressure (PAP) for the treatment of obstructive sleep apnea, adherence remains challenging and negatively affects assessments of effectiveness. It is unclear whether low adherence is due to intolerance of PAP or whether this reflects overall adherence with medical therapy. We sought to correlate PAP use with medication adherence to determine whether poor adherence with PAP was specific to this treatment or represented global compliance with medical therapy.

Methods: A total of 600 consecutive patients with obstructive sleep apnea were treated with PAP. Objective measures of PAP use were correlated with medication adherence. We included all chronically used medications, defined as medications used daily for at least 90 days prior to PAP initiation. Medication use was verified using an electronic health record. PAP adherence ("regular use") was defined as PAP use for ≥ 4 hours/night on ≥ 70% of nights. Medication adherence was defined as > 70% of pills taken as prescribed.

Results: Complete records were available for 566 patients; 361 (63.8%) used chronic medications. The cohort was primarily men (90.3%, age 44.6 ± 10.2 years) with moderate obstructive sleep apnea (apnea-hypopnea index, 18.1 ± 13.9 events/h). In patients on chronic medications, PAP was used 55.8% of nights and 37.7% were regular users. Patients who were adherent with medications used PAP more hours/night (5.4 vs 4.6, P < .001) and were more likely to have regular PAP use compared with those nonadherent with medications (P = .04).

Conclusions: Adherence with PAP correlated with adherence to chronic medications. Low PAP adherence may reflect an individual's global adherence to medical care. This association may lead to better identification of patients who benefit from targeted therapy to improve overall health care adherence.

Citation: Lettieri MJ, Warren WA, Walter RJ, Lettieri CJ. Correlation between positive airway pressure and medication adherence: the healthy user effect. J Clin Sleep Med. 2024;20(7):1087-1092.

Keywords: obstructive sleep apnea; positive airway pressure; treatment compliance.

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Conflict of interest statement

All authors contributed to and approved the manuscript. Work for this study was performed at the Walter Reed National Military Medical Center. The authors report no conflicts of interest. The views reflected this article are those of the authors and do not reflect the official policy of the Department of Defense or the US Government.

Figures

Figure 1
Figure 1. Positive airway pressure (PAP) use vs medication adherence.
See this image and copyright information in PMC

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