Adherence & Non-Adherence To CPAP

Adherence & Non-Adherence To CPAP

Obstructive Sleep Apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you are experiencing sleep apnea, you may snore loudly or make choking noises as you try to breathe then your brain and body become oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night. If you snore loudly and feel tired even after a full night's sleep might be a sign that you have sleep apnea. This type of sleeping disorder should be treated with CPAP.

In medicine, patient compliance, capacitance or adherence describes the degree to which a patient correctly follows medical advice. And non-adherence happens when a patient does not initiate or continue care that a provider has recommended. 

Defining a threshold for clinical benefit 

Using CPAP for less than 4 hours is considered as non-adherence to CPAP treatment. It is said that 4 hours of using CPAP leads to normalization of daytime sleepiness, quality of life, and neurocognitive function. And for a range of 5-7 hours usage improvements in cardiovascular disease and diabetes are improved.  The Centers for Medicare and Medicaid Services (CMS) only requires 4 hours per night for five out of seven nights. However, outcome expectations should be individually defined to determine the appropriate target for nightly usage. The threshold for the usage depends on the goals of the patient.


As per non-adherence the patients only used CPAP for 3hrs and below the estimated count is 29 to 83 percent of patients. Studies show that more than six hours per night results in normal levels of objectively measured and self-reported daytime sleepiness, as well as significantly improved memory and daily functioning.


Following a strict treatment plan is a must and choosing to non-adhere may show a great impact and may mitigate the benefits of the treatment. In one study where a patient tried to have withdrawal for the CPAP treatment, it just led to the recurrence of abnormal respiratory events, increased morning and evening blood pressure, and increased morning heart rate, and daytime sleepiness also increased within two weeks. 

Non-adherence can often be predicted as stemming from a patient’s learning process about the value of treatment.  As patients learn about treatments, they continue effective ones while discontinuing ineffective ones. Non-adherence induced by patient learning provides a powerful force to predict why and how patients do not adhere.

It is identified that non-adherence as a major source of waste in US health care, totaling approximately 2.3% of GDP, and have therefore proposed a plethora of interventions to improve adherence. However, non-adherence is commonly misattributed to ill-informed or irrational patients without an understanding of the underlying forces. This leads to harmful policy efforts to raise adherence by ill-informed policy wonks rather than patients. The administration’s Precision Medicine Initiative is a more useful approach towards appropriate adherence behavior.


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