Psychological Factors Influencing Adherence to
\nNasal Continuous Positive Airway Pressure in
\nObstructive Sleep Apnoea Patients

Obstructive sleep apnoea (OSA) is a chronic sleep-related breathing disorder that if left
\nuntreated leads to serious adverse health consequences, poor quality of life, and also impacts
\nnegatively on society. Continuous positive airway pressure (CPAP) is widely acknowledged as
\nthe best available treatment for moderate to severe OSA. CPAP treatment has been linked to
\nreduced co-morbidities as well as improved quality of life. However, adherence to CPAP therapy
\nis a major obstacle to effective long-term treatment. The aim of this study was to explore and
\nidentify predictors of CPAP adherence in a sample of patients with moderate to severe OSA.
\nSpecifically the study explored; 1) the combination of psychological factors—mood, personality
\nself-efficacy, health locus of control, and health belief—that best predicted adherence and nonadherence
\nto CPAP use; 2) the impact of adherent CPAP use on mood following the
\nimplementation phase; and 3) the impact of adherent CPAP use on sleep-related variables
\ncollected from polysomnography at the diagnostic phase. Traditionally, much of the research on
\nOSA and treatment adherence has focussed on sleep-related variables that are likely to predict
\nCPAP adherence. In contrast, the current study explored the predictive efficacy of psychological
\nfactors. A total of 156 sleep study patients were invited to participate in the present study with 69
\nadherent patients participating in both the diagnostic and implementation phase and 87 nonadherent
\npatients only participating in the diagnostic phase. The sample comprised mainly of
\nmen (65%) diagnosed with moderate to severe OSA, with a mean age of 49 years, and a mean
\nbody mass index of 32. Predictor variables included mood, self-efficacy, personality, health
\nlocus of control, and health beliefs. Results from a discriminant function analysis revealed that
\nanger/hostility, vigour/activity and depression/dejection on the mood measure and self-efficacy,
\ninternal health locus of control, and perceived susceptibility and perceived benefits on the health
\nbelief measure were significant predictors accounting for 59% of the variance of CPAP iii
\nadherence. Cross-validated classification showed that the overall predictive accuracy was 88%.
\nThe results also showed a positive and strong statistically significant reduction in the Apnoea-
\nHypopnoea Index as well as a positive and strong statistically significant increase in O2
\nsaturation at implementation of CPAP use that demonstrated that CPAP treatment continues to
\nremain an effective treatment option for OSA sufferers. While more research is still needed to
\nexploring the predictive value of a range of psychological factors in relation to CPAP nonadherence
\nin moderate to severe OSA patients the present study provides initial useful
\ninformation for predicting adherence and non-adherence. This information is likely to be vital to
\nthe development and design of intervention strategies based on the health belief model to
\nincrease adherence given the prevalence of OSA and non-adherence to CPAP treatment.

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