Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA): how many adhere to treatment?

Keywords: Continuous positive airway pressure (CPAP), CPAP, CPAP alternative, Obstructive Sleep Apnea (OSA), sleep apnea, oral appliance, apnea/hypopnea index (AHI), Dental Sleep Medicine, and Orofacial Pain.

Continuous Positive Airway Pressure (CPAP) is the leading treatment machine for Obstructive sleep apnea (OSA). OSA affects five percent of the adult population and the percentage increases with age. Researchers from Clalit health care services conducted a 4 year study to assess the compliance and long-term use of CPAP machines among patients with OSA. Of the 371 newly diagnosed patients with moderate to severe OSA, about two thirds of the OSA patients were not compliant with the CPAP. However, the regular users of the CPAP achieved a higher score in the Epworth Sleepiness Scale (ESS) and minimal arterial oxygen saturation (SaO2) levels were lower than the patients who were not compliant. Dr. Stan Farrell of Scottsdale, Arizona has extensive training in treating sleep apnea and other sleep disorders. AZ TMJ offers one of the leading alternatives for the CPAP, which is an oral appliance that can be used in conjunction with a CPAP or as a stand-alone oral appliance depending on the severity of the individual’s OSA. If you think you might be suffering from obstructive sleep apnea and have experienced compliance issues with the CPAP, call Dr. Farrell at 480-945-3629 to set your consultation and visit AZ TMJ at

Clalit Health Care Services, Dan/PT district, Tel Hashomer.


INTRODUCTION: Obstructive sleep apnea syndrome (OSA) afflicts approximately 5% of the adult population and increases with age. The gold standard treatment is with the Continuous Positive Airways Pressure (CPAP) machine. Well-designed prospective trials to elucidate long term compliance with CPAP machine are rare.

GOAL: Assessing compliance and long-term use of CPAP machines among patients with OSA who were referred for treatment with this machine.

METHODS: A 4 years prospective cohort observational study was conducted using telephone interviews of 371 newly diagnosed patients with moderate to severe OSA, who received a specialist recommendation to use the CPAP machine which was bought and adjusted to their use.

RESULTS: At the end of the first year, 126 (34%) of the OSA patients used the CPAP machine on a nightly basis (regular users), 120 (32.3%) had not used it at all, and 125 (33.7%) had used it only intermittently. The number of regular users increased between the 1st and 2nd year from 126 (34%), to 163 (44%) (p < 0.07) due to additions from the intermittent users group. The non-users group grew from 120 (32.3%) in the first year, and every year afterwards, up to 221 (59.6%) in the fourth year (p < 0.02). In contrast, there was a significant decrease in the intermittent users group, which declined from 125 (33.7%) in the first year to only 18 (4.8%) in the 4th year (p < 0.005). Most of the patients (92.9%) were males. The average age of the regular users was 59.6 years (+/- 11), which was higher in comparison to 55.9 years (+/- 10.3) for the non-users or 58.9 years (+/- 12.6) among the intermittent users (p = 0.064). There were no statistical differences in co-morbidities or demographics between the three groups. However, the regular users were found to have a higher score in the Epworth Sleepiness Scale (ESS) and a minimal arterial oxygen saturation (SaO2) level lower than the patients in the non-users and intermittent users groups (p = 0.019 and p = 0.03 respectively).

CONCLUSIONS: Four years follow-up revealed that about two thirds of the OSA patients did not use the CPAP machine. Older age, higher scores on the ESS questionnaire and lower 02 saturation levels on the polysomnogram (PSG) predict better adherence to treatment with the CPAP machine. In light of our findings and high treatment costs, we suggest a better selection process for prescribing CPAP treatment based on the above mentioned criteria. Other treatment modalities may be considered for patients not compliant with CPAP treatment or those who refuse to use it. Ongoing medical and social support is needed in order to maintain good compliance.