Depression May Reduce Adherence During CPAP Titration Trial

Overview

Journal J Clin Sleep Med

Specialties Neurology
Psychiatry

Date 2014 Feb 18

PMID 24532999

Citations 29

Authors

Mandy Law

Matthew Naughton

Sally Ho

Teanau Roebuck

Eli Dabscheck

Affiliations

Soon will be listed here.

Abstract

Study Objectives: Depression is a risk factor for medication non-compliance. We aimed to identify if depression is associated with poorer adherence during home-based autotitrating continuous positive airway pressure (autoPAP) titration.

Design: Mixed retrospective-observational study.

Setting: Academic center.

Participants: Two-hundred forty continuous positive airway pressure-naïve obstructive sleep apnea (OSA) patients.

Measurements: Patients underwent approximately 1 week of home-based autoPAP titration with adherence data downloaded from the device. Electronic hospital records were reviewed in a consecutive manner for inclusion. Three areas of potential predictors were examined: (i) demographics and clinical factors, (ii) disease severity, and (iii) device-related variables. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Scores on the subscales were categorized as normal or clinical diagnoses of depression (≥ 8) and anxiety (≥ 11). The primary outcome variable was the mean hours of autoPAP used per night.

Results: Patients were diagnosed with OSA by either attended polysomnography (n = 73, AHI 25.5[15.1-41.5]) or unattended home oximetry (n = 167, ODI3 34.0[22.4-57.4]) and had home-based autoPAP titration over 6.2 ± 1.2 nights. Mean autoPAP use was 4.5 ± 2.4 hours per night. Multiple linear regression analysis revealed that depression and lower 95(th) percentile pressures significantly predicted lesser hours of autoPAP use (R(2) = 0.19, p < 0.001). Significantly milder OSA in those requiring lower pressures may have confounded the relationship between 95(th) percentile pressure and autoPAP use.

Conclusion: Depression was independently associated with poorer adherence during home-based autoPAP titration. Depression may be a potential target for clinicians and future research aimed at enhancing adherence to autoPAP therapy.

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