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Kim, Kim, Bae, Park, and Kim: Predictors of Adherence with Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea in Korean
Original Article

J Rhinol 2015;22(2):89-95.

Published online: 10 January 2015

DOI: https://doi.org/10.18787/jr.2015.22.2.89

Predictors of Adherence with Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea in Korean

Jin Myung Kim1, *, Min Jae Kim1, *, Sung Hee Bae1, Chan Hum Park1, 2, Dong-Kyu Kim1, 2

1Departments of Otorhinolaryngology-Head Neck Surgery, Chuncheon Sacred Heart Hospital, Chuncheon

2Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, Chuncheon, Korea

교신저자：김동규, 24253 강원도 춘천시 교동 153 한림대학교 의과대학 춘천성심병원 이비인후-두경부외과학교실 Tel: +82-33-240-5181, Fax: +82-33-241-2909, E-mail: doctordk@naver.com

This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2015R1A4A 1041631), Republic of Korea

* Myung Jin Kim

* Min Jae Kim

* equally contributed to the work

Received 29 April 2015       Revised 6 June 2015       Accepted 27 August 2015

Copyright © 2015 Journal of Rhinology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

Application of automatic positive airway pressure (APAP) is regarded as the primary therapy for patients with obstructive sleep apnea syndrome (OSAS). However, a low adherence rate is a major problem with APAP treatment in OSAS patients. Therefore, the aim of the present study is to assess factors related to good adherence of APAP therapy in OSAS Korean patients.

Materials and Method

Of 112 consecutive newly diagnosed moderate to severe OSAS patients, 70 were enrolled in this study. All patients received APAP therapy for 2 weeks, along with reinforcing intervention, consisting of motivational reinforcement and technical support. All APAP therapy involved a device rental service. After 2 weeks of treatment, patients had to choose the kind of treatment for OSAS [APAP therapy (good adherence) or alternative treatment options (poor adherence)].

Results

After 6 months, the adherence rate to APAP therapy was 35.7% (n=25). No statistically significant difference was observed between the good and poor adherence groups with regard to snoring intensity, apnea-hypopnea index, and mean O2 saturation after adjusting for age, sex, body mass index, marital status, and socioeconomic status. However, we found that excessive daytime sleepiness and lowest O2 saturation were significantly associated with good adherence [adjusted odds ratios (ORs)=9.515 and 2.327] after adjusting for age, sex, body mass index, marital status, and socioeconomic status.

Conclusion

Our findings suggest that excessive daytime sleepiness and lowest O2 saturation are important factors to identify good adherence to APAP treatment in Korean OSAS patients.

Keywords: Obstructive sleep apnea syndrome, Automatic positive airway pressure, Adherence.

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Table 1.
General characteristics of study population
Characteristics n=70
Age, years 48.0±11.3
Male, % 57 (81.4%)
Body mass index (BMI) 27.2±3.9
Married, n (%) 48 (68.6%)
White color, n (%) 41 (58.6%)
College education, n (%) 40 (57.1%)
Comorbid medical illness, n (%) 31 (44.3%)
ESS score 8.4±2.3
PSQI score 6.8±1.1
Snoring intensity, dB 42.9±1.8
Apnea-hypopnea index 28.7±12.7
Mean SpO2, % 90.6±2.0
Lowest SpO2, % 73.1±8.1
Therapeutic PAP pressure 10.3±1.9
Table 2.
Comparison analysis between good adherent and poor adherent
Variables Good adherent (n=25) Poor adherent (n=45) p vale
Age, years 47.0 48.6 0.582
Male, % 20 (80.0%) 37 (82.5%) 0.819
Body mass index (BMI) 27.9 26.9 0.306
Married, n (%) 20 (80.0%) 28 (62.2%) 0.125
White color, n (%) 17 (68.0%) 24 (53.3%) 0.233
College education, n (%) 17 (68.0%) 23 (51.1%) 0.171
Comorbid medical illness, n (%) 13 (52.0%) 18 (40.0%) 0.333
ESS score 9.48 7.84 0.003
PSQI score 6.7 6.8 0.713
Snoring intensity, dB 43.0 42.8 0.632
Apnea-hypopnea index 27.4 29.4 0.539
Mean SpO2, % 91.2 90.3 0.062
Lowest SpO2, % 70.4 74.7 0.033
Therapeutic PAP pressure 10.3 10.4 0.811
Table 3.
Logistic regression analyses to identify associated with good adherence to positive airway pressure treatment in patients with obstructive sleep apnea syndrome
Variables Multivariate analysis
Odds ratio 95% CI
Age, years 1.113 0.999 1.241
Male, % 0.365 0.167 0.795
Body mass index (BMI) 0.795 0.595 1.062
Married, n (%) 0.838 0.489 1.435
White color, n (%) 1.993 0.137 2.924
Comorbid medical illness, n (%) 1.017 0.984 1.151
ESS score 9.515 1.627 14.361
PSQI score 1.906 0.705 5.150
Snoring intensity, dB 0.752 0.447 1.264
Apnea-hypopnea index 1.075 0.961 1.203
Lowest SpO2, % 2.327 1.037 5.225
Therapeutic PAP pressure 0.485 0.232 1.014
Table 4.
Comparison analysis between good adherent and poor adherent
Variables Good adherent (n=25) Poor adherent (n=45) p vale
Risk perception score 2.6±0.9 2.7±1.0 0.711
Outcome expectancy score 3.1±1.0 2.9±1.0 0.517
Treatment self-efficacy score 4.1±0.8 2.6±0.9 0.001
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