Early CPAP-Usage Patterns Predict Long-Term Adherence in OSA Patients: Study Reveals

The researchers found that early patterns of CPAP usage could help predict long-term adherence in patients with OSA. They identified six distinct behavioral patterns, with 62% of patients being non-adherent by the third month. Interestingly, 98% of those who failed to adhere to CPAP therapy showed signs of non-compliance within the first month. These findings suggest that making adjustments as early as the second week could enhance treatment outcomes.

The researchers note that high rates of non-adherence to continuous positive airway pressure therapy in obstructive sleep apnoea pose a significant challenge to achieving optimal clinical outcomes. Current recommendations categorize patients into two groups—adherent and non-adherent—and suggest follow-ups between days 7 and 90 after CPAP initiation to address adherence issues. However, this approach may not be sufficient to prevent long-term non-compliance.

To better understand this issue, Julia Dielesen, National Heart and Lung Institute, Imperial College London, London, UK, and colleagues investigated how early CPAP-usage behaviours relate to adherence at three months and examined how sleep centers’ treatment pathways—such as patient support strategies and procedural interventions—may influence CPAP adherence. By identifying distinct early usage patterns, the study aimed to improve adherence prediction and enable tailored interventions that enhance long-term treatment success.

For this purpose, the researchers conducted growth mixture modelling (GMM) using retrospective data from 1,000 patients across five UK sleep centres. They analyzed telemonitored CPAP usage data from the first night to the third month, selecting 200 patients per centre who initiated CPAP therapy in 2019 or 2020. Adherence was determined based on established criteria, defining it as an average CPAP usage of at least four hours per night for 70% or more of the monitored nights.

The following were the key findings of the study:

• Researchers identified six distinct CPAP-usage behaviour patterns within the first month.
• In 54% of patients, CPAP usage either increased or decreased over time.
• The remaining 46% showed consistent CPAP usage or non-usage throughout.
• By the third month, 62% of patients were non-adherent, despite following current recommendations.
• Among those who were non-adherent at month 3, 98% had already shown signs of non-adherence by month 1.
• Regression analysis on a separate dataset revealed that early CPAP usage behaviour accounted for 86% of the variation in CPAP non-adherence at month 3.

The researchers highlight that current follow-up recommendations (days 30–90) are too late to prevent CPAP non-adherence. Their findings show that assessing CPAP-usage behaviours by week 2 can predict non-adherence at month 3, enabling timely interventions. Despite CPAP being the most effective OSA treatment, adherence remains low, with only 38% of patients consistently using it after three months.

The researchers identified six behavioural patterns linked to long-term adherence and stressed the need for follow-ups within the first three weeks. Their classification offers valuable insights for future research, allowing tailored strategies to improve CPAP adherence and optimize patient outcomes.

Reference:

Dielesen J, Ledwaba-Chapman LJ, Kasetti P, et al. Six early CPAP-usage behavioural patterns determine peak CPAP adherence and permit tailored intervention in patients with obstructive sleep apnoea. Thorax Published Online First: 27 February 2025. doi: 10.1136/thorax-2024-221763