A Brief Survey of Patients’ First Impression After CPAP Titration Predicts Future CPAP Adherence: A Pilot Study

Study Questions:

Can a questionnaire predict continuous positive airway pressure (CPAP) adherence?


This single-center retrospective study was conducted to examine the association between adherence of CPAP therapy at 30 days and CPAP perception questionnaire among 1,126 patients screened between July 2007 and June 2008. Patients were excluded for lacking obstructive sleep apnea (n = 88), pursuing other forms of therapy or lack of titration study (n = 252), or lack of adherence data (n = 383). A total of 403 CPAP-naïve adults undergoing in-laboratory titration studies were analyzed. Adherence was analyzed with wireless technology by daily downloading data (hours/night used) for the first 30 days of use. The questionnaire included six questions: 1) How much difficulty did you have tolerating CPAP? 2) How uncomfortable was the mask? 3) How uncomfortable was the CPAP pressure? 4) What is the likelihood of you wearing the equipment at night almost every night? 5) How beneficial do you think CPAP is going to be for your health and sleep? 6) What is your attitude towards CPAP therapy? These questions were answered on an analog scale ranging from 1 (no difficulty/no discomfort/positive attitude toward CPAP) to 10 (significant difficulty/significant discomfort/negative attitude toward CPAP).


Mean age was 52 ± 14 years; 47% were men. Mean body mass index was 36.3 ± 9.1 kg/m2. Only questions 1, 3, 4, and 5 were significantly correlated with mean 30-day CPAP adherence. Stepwise linear regression modeling demonstrated that three variables were significant and independent predictors of reduced mean CPAP adherence: worse score on the four-item questionnaire, African-American race, and nonsleep specialist ordering CPAP therapy. Variables that were not predictive of CPAP adherence in the regression analysis were age, gender, BMI, obstructive sleep apnea severity, education level, and insurance status. Moreover, there was no significant interaction between race or physician specialty and the CPAP perception score.


The authors concluded that a brief CPAP perception questionnaire administered to patients immediately following a CPAP titration study predicts CPAP adherence during the first 30 days. This suggests that a brief, clinical evaluation of patient attitudes regarding CPAP therapy can have important predictive value.


This study demonstrates the clinical utility and predictive power of a practical and simple questionnaire for post-CPAP titration assessment of patients’ perceptions. Those patients with scores suggesting an increased risk of nonadherence can then be targeted for interventions designed to improve adherence. These findings need to be validated prospectively in different patient populations, including those on outpatient follow-up.

Clinical Topics: Heart Failure and Cardiomyopathies, Sleep Apnea

Keywords: Body Mass Index, Cardiology, Continuous Positive Airway Pressure, Pregnancy, Prolonged, Sleep Apnea, Obstructive, Sleep Apnea Syndromes, United States

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