The individual and societal prices of non-adherence to continuous positive airway pressure, contributors, and strategies for improvement

ABSTRACT

Introduction

Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea (OSA). CPAP is highly effective for improving symptoms and quality of life, but the major issue is adherence, with up to 50% of OSA discontinuing CPAP in the first 3 years after CPAP initiation.

Areas covered

We present the individual and societal costs of non-adherence to CPAP, factors associated with non-adherence to CPAP, as well as current strategies for improving adherence including telehealth, couple-based interventions, and behavioral interventions. We also report on challenges and pitfalls for the visualization and analysis of CPAP remote monitoring platforms.

Expert opinion

CPAP termination rates and adherence to therapy remain major issues despite technical improvements in CPAP devices. The individual and societal price of non-adherence to CPAP for OSA patients goes beyond excessive sleepiness and includes cardiovascular events, all-cause mortality, and increased health costs. Strategies for improving CPAP adherence should be individually tailored and aim to also improve lifestyle habits including physical activity and diet. Access to these strategies should be supported by refining visualization dashboards of CPAP remote monitoring platforms, and by disseminating telehealth and innovative analytics, including artificial intelligence.

KEYWORDS:

• Adherence
• continuous positive airway pressure
• couple
• data visualization
• obstructive sleep apnea
• socio-economic
• telemedicine

Article highlights

• CPAP termination rates remain very high, and adherence to therapy is a major issue. In the last 20 years, no significant improvement in CPAP adherence has been observed despite obvious improvements in technical aspects of devices.

• OSA severity, as assessed by apnea–hypopnea index, and technical aspects relative to CPAP devices seem to be minor contributors in explaining CPAP adherence.

• Other factors (comorbidities, psychological, couples profile, socio-economic status, access to care, and cultural diversity) should be better acknowledged and included in tailored interventions.

• Strategies for improving CPAP adherence should be individually personalized and aim to improve not only CPAP adherence but also global lifestyle habits including physical activity and diet.

• Access to these strategies should be supported by improving visualization dashboards of CPAP remote monitoring platforms and by disseminating telehealth and innovative analytics including artificial intelligence.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

JL Pépin, F Bettega, S Bailly, S Baillieul, and R Tamisier are supported by the French National Research Agency in the framework of the ’Investissements d’aveni’ program (ANR-15-IDEX-02) and Grenoble Alpes University Foundation (ANR-19-P3IA-0003) ‘Chair of excellence’ ‘e-health and integrated care and trajectories medicine and MIAI artificial intelligence’. J Duval is supported by LVL Medical and The Grenoble Multidisciplinary Institute for Artificial Intelligence (MIAI) in the framework of a ‘Convention Industrielle de Formation par la Recherche’ (CIFRE) PhD.