PAP non-adherence in the clinical practice– a clinical case series  

Introduction PAP therapy is considered the gold standard treatment for obstructive sleep apnea (OSA). However, therapy adherence is often limited. PAP non-adherence was recently defined in a review paper for the first time. In this patient cohort, we aim to investigate the characteristics and reasons for limited PAP adherence.

Methods Retrospectively, 53 patients presenting with the question of UAS (upper airway stimulation) in 2019 and 2020 were included. Data on self-reported and sleep history, polygraphy, drug-induced sleep endoscopy, and PAP therapy were collected.

Results Moderate to severe OSA predominated in this patient cohort, with a mean AHI of 35.9/h and an Epworth Sleepiness Scale score of 10.6. PAP intolerance was present in 60.4%, PAP discontinuance in 28.3%, PAP incompatibility and PAP non-acceptance in 5.7% each. PAP therapy was used for 2.7 h per night over 2.9 years. For therapy optimization, 3.2 masks were tried and the therapy mode was changed in 13 cases. The most common subjective reasons for PAP non-adherence were mask problems in 64%, followed by mask-induced panic attacks in 36% or insomnia in 32%. Pathophysiologic causes of insufficient care included Cheyne Stokes breathing in 11%, supine-related OSA in 5%, tonsillar hyperplasia in 3%, or aerophagia in 3%.

Discussion PAP non-adherence can have multiple causes and requires comprehensive diagnosis, patient counseling, and education. By establishing an individual treatment plan, this challenging patient population can be reintroduced to adequate therapy.

Publication History

Article published online:
24 May 2022