Interventions to Improve Compliance in Sleep Apnea Patients Previously Non-Compliant with Continuous Positive Airway Pressure
Open accessAbstract
Study objectives Despite widespread agreement that continuous positive airway pressure is effective therapy for obstructive sleep apnea, it is estimated that 50% of patients recommended for therapy are noncompliant 1 year later. Interventions to improve compliance in such patients have not been studied. We evaluated a 2 phase intervention program to improve compliance in sleep apnea patients previously noncompliant with continuous positive airway pressure.Methods 204 patients with previously diagnosed obstructive sleep apnea and noncompliant with continuous positive airway pressure were enrolled. Phase 1 evaluated standard interventions to improve therapy compliance, including mask optimization, heated humidification, topical nasal therapy, and sleep apnea education. Persistently noncompliant patients proceeded to phase 2, where compliance was compared in double-blind randomized fashion between standard continuous positive airway pressure and flexible bilevel positive airway pressure.Results 49 (24%) of 204 previously noncompliant patients became compliant (average nightly use > or =4 hours) after standard interventions. Then 104 of the 155 persistently noncompliant patients agreed to continue and were randomized to either CPAP or flexible bilevel positive airway pressure retitration and treatment for an additional ninety days. At follow-up 15 (28%) of the 53 randomized to CPAP and 25 (49%) of the 51 randomized to flexible bilevel positive airway pressure (p = 0.03) achieved compliance.Conclusions A two phase intervention program, first employing standard interventions, followed by a change to flexible bilevel airway pressure, can achieve improved compliance in patients previously noncompliant with continuous positive airway pressure.
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Ballard et al. examined 100 patients persistently noncompliant with CPAP after mask optimization, humidification, and education and performed a double-blind randomized trial of standard CPAP versus bilevel PAP, showing that more participants in the bilevel PAP group achieved compliance of PAP use more than 4 hours per night.
“Ballard et al.1041 examined 100 patients who were persistently noncompliant with CPAP after mask optimization, humidification, and education measures and performed a double-blind randomized trial of standard CPAP versus BPAP use and showed more participants in the BPAP group achieved compliance of PAP use more than 4 h per night.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1041]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe study using BPAP with a modified pressure profile as a rescue therapy in participants nonadherent to CPAP after ≥ 2 weeks demonstrated a clinically significant increase in the point estimate adherence of 0.8 h/night (95% CI: -0.03 to 1.6 h/night) in the BPAP compared to the CPAP group, although the precision was very low.
“The study using BPAP with a modified pressure profile as a rescue therapy in participants nonadherent to CPAP after ≥ 2 weeks demonstrated a clinically significant increase in the point estimate adherence of 0.8 h/night (95% CI: -0.03 to 1.6 h/night) in the BPAP compared to the CPAP group, although the precision was very low.209”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [209]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredOnly one study, which assessed participants that were CPAP intolerant, suggests that BPAP might improve adherence, although the precision in this study was very low and precluded any definitive statements.
“Only one study, which assessed participants that were CPAP intolerant, suggests that BPAP might improve adherence, although the precision in this study was very low and precluded any definitive statements.209”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [209]
In Phase 2 (page not provided), previously CPAP-noncompliant patients assigned to BiFlex had higher adherence than those continuing CPAP (49% versus 28%). The Discussion notes the study’s relatively small size, but its caution against definitive conclusions concerns BiFlex versus standard bilevel PAP, which was not tested; it does not describe the adherence result as having very low precision. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNeither study demonstrated a clinically significant difference in quality of life between BPAP and CPAP as assessed by the FOSQ.
“Neither study 209,210 demonstrated a clinically significant difference in QOL between BPAP and CPAP as assessed by the FOSQ”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [209]
The Phase 2 and Discussion passages report FOSQ measurements in the CPAP and BiFlex groups, but do not establish whether the between-group difference was clinically significant. The Discussion says FOSQ scores increased significantly only within the BiFlex group and explicitly cautions that standard bilevel PAP was not studied. Thus this paper cannot support the claim as stated for BPAP versus CPAP; the other cited study is outside this verdict. (LLM, conf=0.83)
Experimental — accuracy not yet measuredOnly one study included participants who had previously showed nonadherence with CPAP (< 4 h/night), whereas the other 4 studies included PAP naïve participants.
“Only one study included participants who had previously showed nonadherence with CPAP (< 4 h/ night), 209 whereas the other 4 studies included PAP naïve participants.[210][211][212][213]”
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- Authors
- Ballard, R. D., Gay, P. C., & Strollo, P. J.
- Affiliations
- National Jewish Health (US)
- Mayo Clinic (US)
- University of Pittsburgh (US)
- Corresponding author
- Ballard, Robert D.
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2007-12-15
- Volume
- 3
- Issue
- 7
- Pages
- 706-712
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC2556913
- OpenAlex
- W151674178
- Semantic Scholar
- 28162e2ba471d9b064a7f631000ff70690895394
- Cited by
- 137
- References
- 29
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 8 · 2018: 7 · 2017: 3 · 2016: 15 · 2015: 4 · 2014: 18 · 2013: 11 · 2012: 6
- FWCI
- 6.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- ResMed
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- obstructive sleep apnea, continuous positive airway pressure, mask optimization, heated humidification, medication adherence
- MeSH terms
- Aged, Double-Blind Method, Equipment Design, Female, Heating, Humans, Humidity, Long-Term Care, Male, Masks, Middle Aged, Patient Compliance, Patient Education as Topic, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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