14 The Wisconsin Sleep Cohort Study found that patients with moderate-to-severe untreated obstructive sleep apnea (OSA) were 4 to 5 times more likely to die of a cardiovascular event and 3 times more likely to die of any cause. Other factors, such as race and economic status, also affect adherence. 1Īdherence is affected by many factors, including heated humidity, patient education, mask type, and type of PAP machine (eg, continuous PAP vs bilevel PAP auto-PAP vs CPAP). 1– 13 A majority of patients indicated that mask discomfort is the primary reason for nonadherence. Several recent studies have confirmed widely varying PAP therapy adherence rates (30%–84%). The importance of PAP therapy and the reasons veterans should sleep with a PAP machine for 7 to 9 hours each night are stressed (many sleep only 4 to 5 hours). Dingell VA Medical Center in Detroit (VAMC Detroit) developed the O’Brien criteria and extensive patient education materials to increase patient adherence. Adherence to positive airway pressure (PAP) therapy is a difficult patient management issue.
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