Adherence

Despite its demonstrated efficacy for treating OSA (128-130), there is some concern that CPAP adherence consistently falls below expectations. Some studies have demonstrated that the majority of patients who are prescribed CPAP either discontinue it completely or fail to use it at recommended levels (i.e., all night every night) (131,132). A review of the past 50 years of adherence to medical treatments concluded that the poorest adherence was associated with the treatment of sleep disorders (133). The majority of these studies involved treatment with CPAP. Using liberal definitions of adherence, 65% of patients were adherent with CPAP therapy compared to an overall average of 75% for all medical disorders. The continual report of low adherence may lead providers to accept less than optimal adherence, recognizing that they are limited in an attempt to try to achieve higher rates. This point is further exacerbated by the fact that few studies to date have identified the level of adherence needed to remedy some of the more common sequelae of the disorder. Moreover, there is no field standard for adherence, leading some to report adequate adherence in participants that would be characterized as suboptimal or poor by others' standards. There have been some studies and meeting presentations that suggest necessary levels of adherence to reduce the risk of cardiovascular disease and remedy functional problems (134,135). These studies generally point to use of six or more hours a night, levels less frequently reached in naturalistic studies. Perhaps the initial step to improving adherence lies in better understanding adherence as a dependent measure and what factors influence adherence over time.

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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