Obstructive Sleep Apnea Patients’ Compliance with Treatment of Continuous Positive Airway Pressure: A Literature Review


  • Chestharid Borriboon Faculty of Nursing, CMU
  • Jindarat Chaiard Faculty of Nursing, CMU
  • Chiraporn Tachaudomdach Faculty of Nursing, CMU


adherence, continuous positive airway pressure, relevant factors, obstructive sleep apnea


     Obstructive sleep apnea (OSA) is a disorder caused by constriction of the upper respiratory tract during sleep, resulting in hypoxia and sleep disturbances. Obstructive sleep apnea requires specifc treatment using continuous positive airway pressure (CPAP), which is a high-effcacy standard method of treatment. To obtain maximum beneft of the CPAP treatment, the patient’s compliance is an essential factor. However, it is presently found that OSA patients’ compliance with this method of treatment is at a relatively low level. Causes of this could vary from physiological factors, such as sex, age, and symptomatic severity, which are immutable, to psychosocial and cognitive factors, such as perception of susceptibility, severity, benefts, self-effcacy, and obstacles, which are adjustable or ameliorable.
      This article primarily attempts to increase nurses’ or healthcare professionals’ understanding of factors related to patients’ compliance with the treatment. With such factors properly managed, treatment compliance can be promoted, which could reduce complications and expenses to be incurred. Accordingly, nurses are advised to conduct regular assessments of the CPAP machine, make regular enquiries about the patients’ problems and obstacles in using the machine, and promote the patients’ self-effcacy in using the CPAP machine, to encourage the patients’ compliance with the treatment method.


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Sleep Society of Thailand. Clinical recommendations for diagnosis and management of obstructive sleep apnea in Thailand for adults 2017. Thailand: The Institute; 2017. (in Thai)

Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017; 34:70-81.

Spicuzza L, Caruso D, Di M. Obstructive sleep apnea syndrome and its management. Ther Adv Chronic Dis

; 6(5):273-85.

Stetler CB. Utilization focused integrative reviews in nursing service. Appl Nurs Res 1998;11(4):195-206.

Neelapu BC, Kharbanda OP, Sardana HK, Balachandran R, Sardana V, Kapoor P, et al. Craniofacial and upper

airway morphology in adult obstructive sleep apnea patients: a systematic review and meta-analysis of

cephalometric studies. Sleep Med Rev 2017; 31:79-90.

Sawatari H, Chishaki A, Nishizaka M, Tokunou T, Adachi S, Yoshimura C, et al. Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing. Am J Hypertens 2016;29(4):458-63.

Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017;13(03): 479-504.

Kositanurit W, Muntham D, Udomsawaengsup S, Chirakalwasan NS, Breathing Prevalence and associated factors of obstructive sleep apnea in morbidly obese patients undergoing bariatric surgery. Sleep Breath 2018;22(1):251-6.

Quan S, Gillin JC, Littner M, Shepard JS. Sleep-related breathing disorders in adults: recommendations for

syndrome defnition and measurement techniques in clinical research. Sleep 1999;22(5):662-89.

Naik S, Al H, Kreinin I, Kryger M. Centers for Medicare and Medicaid Services positive airway pressure adherence criteria may limit treatment to many medicare benefciaries. J Clin Sleep Med 2019;15(2):245-51.

Choi JA, Yoon IY, Han EG, Lee SJ. Subjective and objective CPAP compliance in patients with obstructive

sleep apnea syndrome. Sleep Med Res 2011;2(2):63-8.

Rotenberg BW, Murariu D, Pang KP, Surgery N. Trends in CPAP adherence over twenty years of data

collection: a flattened curve. J Otolaryngol Head Neck Surg 2016;45(1):43.

Lee CH, Leow LC, Song PR, Li H, Ong TH. Acceptance and adherence to continuous positive airway pressure

therapy in patients with obstructive sleep apnea in a Southeast Asian privately funded healthcare system. Sleep Sci 2017;10(2):57.

Chaiard J, Theerakittikul T, Deeluae J. The effect of continuous positive airway pressure on sleep quality, daytime sleepiness, and daytime functioning among Thai patients with obstructive sleep apnea. J Med Assoc Thai 2017.

Ancoli l, Palmer S, Cooke BW, CoreyBloom JR, Fiorentino J, Natarajan L, et al. Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J Am Geriatr Soc 2008;56(11):2076-81.

Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. JCSM 2019;15(2):335.

Linz D, McEvoy RD, Cowie MR, Somers VK, Nattel S, Lévy P, et al. Associations of obstructive sleep apnea

with atrial fbrillation and continuous positive airway pressure treatment. JAMA Cardiol. 2018;3(6):532-40.

Tamanna S, Campbell D, Warren R, Ullah MI. Effect of CPAP therapy on symptoms of nocturnal gastroesophageal reflux among patients with obstructive sleep apnea. J Clin Sleep Med 2016;12(09):1257-61.

Chen L, Kuang J, Pei JH, Chen HM, Chen Z, Li ZW, et al. Continuous positive airway pressure and diabetes

risk in sleep apnea patients: a systemic review and meta-analysis. Eur J Intern Med 2017; 39:39-50.

Richards KC, Gooneratne N, Dicicco B, Hanlon A, Moelter S, Onen F, et al. CPAP adherence may slow 1-year cognitive decline in older adults with mild cognitive impairment and apnea. J Am Geriatr Soc 2019;67(3):558-64.

Cabezas P, Ruiz V, Jimenez C, Gonzalez G, Galan G, Martin A. Continuous positive airway pressure treatment in patients with Alzheimer’s disease: a systematic review. J. Clin. Med. 2020; 9:181.

Jara SM, Hopp ML, Weaver TE, Surgery N. Association of continuous positive airway pressure treatment with

sexual quality of life in patients with sleep apnea: Follow-up Study of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2018;144(7):587-93.

Patel SR, Nouraie SM, Stitt CJ, Bakker JP, Aloia MSJS. 0513 Variability in CPAP adherence: a national perspective. Sleep 2019;42: A206.

Sawunyavisuth B. What personal experiences of CPAP use affect CPAP adherence and duration of CPAP

use in OSA patients. J Med Assoc Thai 2018; 101(7):245.

Ghadiri M, Grunstein RR. Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea. Respirology 2020;25(6): 593-602.

Olsen S, Smith S, Oei TP, Douglas J. Health belief model predicts adherence to CPAP before experience with CPAP. Eur Respir J 2008;32(3):1-8.

Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q 1988;15(2):175-83.

Sage CE, Southcott AM, Brown SL. The health belief model and compliance with CPAP treatment for obstructive sleep apnoea. Behav Change 2001; 18(3):177-85.

Stepnowsky CJ, Marler MR, Palau J, Brooks JA. Social-cognitive correlates of CPAP adherence in experienced users. Sleep Med 2006;7(4): 350-56.

Balachandran JS, Yu X, Wroblewski K, Mokhlesi B. A brief survey of patients’ frst impression after CPAP titration predicts future CPAP adherence: a pilot study. J Clin Sleep Med 2013;9(3):199-205.

Saconi B, Yang H, Watach AJ, Sawyer AM. Coping processes self-efficacy and CPAP use in adults with obstructive sleep apnea. Behav Sleep Med 2018.

Lai AY, Fong DY, Lam JC, Weaver TE, Ip MS. The efficacy of a brief motivational enhancement education

program on CPAP adherence in OSA: a randomized controlled trial. Chest 2014;146(3):600-10.

Bakker JP, Wang R, Weng J, Aloia MS, Toth C, Morrical MG, et al. Motivational enhancement for increasing adherence to CPAP: a randomized controlled trial. Chest 2016;150(2):337-45.



How to Cite

Borriboon C, Chaiard J, Tachaudomdach C. Obstructive Sleep Apnea Patients’ Compliance with Treatment of Continuous Positive Airway Pressure: A Literature Review. TJNC [Internet]. 2021 Sep. 23 [cited 2022 Nov. 28];36(04):17-30. Available from: https://he02.tci-thaijo.org/index.php/TJONC/article/view/243085