Sleep Onset Insomnia and Depression Discourage Patients from Using Positive Airway Pressure

ABSTRACT

OBJECTIVES: Despite the accumulating evidence of the effectiveness of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) syndrome, adherence to PAP therapy is not high. Several factors reportedly affect PAP adherence; however, it remains unclear whether patients' symptoms were detrimental to adherence rate. This study is aimed at investigating the relationship between insomnia symptoms and adherence. METHODS: Retrospective analyses were performed in 359 patients with OSA (mean age 58.4±13.2 years; females, n=80). Logistic regression analyses were performed between PAP adherence with clinical factors and questionnaires, such as Epworth Sleepiness Scale, Insomnia Severity Index, and Beck Depression Inventory (BDI). RESULTS: PAP adherence was defined as the use of PAP for ≥4 h per night on 70% of nights during 30 consecutive days. The median follow-up time was 55 days (interquartile range, 30–119 days), and 54.3% showed poor adherence. Non-adherent patients showed more severe sleep onset insomnia, higher BDI, and higher nadir oxygen saturation (SaO₂). Patients with good adherence had higher apnea–hypopnea index, oxygen desaturation index, and respiratory arousal to total arousal ratio. Sleep onset insomnia [odds ratio (OR)=1.792, p=0.012], BDI (OR = 1.055, p=0.026), and nadir SaO₂ (OR=1.043, p=0.040) were independently associated with PAP non-adherence. CONCLUSIONS: Not the severity of insomnia but sleep onset insomnia was associated with PAP adherence, as well as depressive mood. It suggests that different interventions for reducing insomnia and depressive mood are needed to increase PAP adherence in patients with OSA.