Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients

• Published in: PloS one Vol. 6; no. 8; p. e22503
• Main Authors: Gagnadoux, Frédéric, Le Vaillant, Marc, Goupil, François, Pigeanne, Thierry, Chollet, Sylvaine, Masson, Philippe, Humeau, Marie-Pierre, Bizieux-Thaminy, Acya, Meslier, Nicole
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.08.2011; Public Library of Science (PLoS)
• Subjects: Adhesion; Aged; Apnea; Body mass; Body Mass Index; Body size; Care and treatment; Cohort analysis; Continuous positive airway pressure; Economic factors; Employment; Employment - statistics & numerical data; Female; Health risk assessment; Hospitals; Humanities and Social Sciences; Humans; Inflammatory bowel disease; Laboratories; Male; Marital Status - statistics & numerical data; Medical diagnosis; Medical research; Medical treatment; Medicine; Middle Aged; Neuromuscular diseases; Patient compliance; Patient Compliance - statistics & numerical data; Patients; Positive-Pressure Respiration - methods; Pressure; Prospective Studies; Quality of life; Regression Analysis; Respiratory tract; Risk; Severity of Illness Index; Sleep; Sleep and wakefulness; Sleep apnea; Sleep Apnea, Obstructive - pathology; Sleep Apnea, Obstructive - therapy; Sleep disorders; Sleepiness; Social factors; Socio-economic aspects; Socioeconomic factors; Socioeconomics; Studies; Systematic review; Time Factors; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0022503

Long-term adherence is a major issue in patients receiving home continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS). In a multicenter prospective cohort (the Institut de Recherche en Santé Respiratoire des Pays de la Loire [IRSR] sleep cohort) of consecutive OSAHS patients in whom CPAP had been prescribed for at least 90 days, we studied the impact on long-term treatment adherence of socioeconomic factors, patients and disease characteristics prior to CPAP initiation. Among 1,141 patients in whom CPAP had been prescribed for an average of 504±251 days (range: 91 to 1035), 674 (59%) were adherent with a mean daily use of CPAP≥4 h (mean: 6.42±1.35 h). Stepwise regression analysis identified 4 independent factors of CPAP adherence including apnea-hypopnea index (AHI) (OR: 1.549, 95%CI 1.163 to 2.062 for AHI≥30 vs. AHI<30; p = 0.003), body mass index (BMI) (OR: 1.786, 95%CI 1.131 to 2.822 for BMI≥25 and <30 kg/m(2), p = 0.01; OR: 1.768, 95%CI 1.145-2.731 for BMI≥30 kg/m(2), p = 0.01 vs. BMI<25 kg/m(2)), employment status (OR: 1.414, 95%CI 1.097-1.821 for retired vs. employed; p = 0.007) and marital status (OR: 1.482, 95%CI 1.088-2.019 for married or living as a couple vs. living alone; p = 0.01). Age, gender, Epworth sleepiness scale, depressive syndrome, associated cardiovascular morbidities, educational attainment and occupation category did not influence CPAP adherence. Marital status and employment status are independent factors of CPAP adherence in addition to BMI and disease severity. Patients living alone and/or working patients are at greater risk of non-adherence, whereas adherence is higher in married and retired patients. These findings suggest that the social context of daily life should be taken into account in risk screening for CPAP non-adherence. Future interventional studies targeting at-risk patients should be designed to address social motivating factors and work-related barriers to CPAP adherence.