# Polysomnographic parameters predicting positive airway pressure adherence

## TL;DR

This study finds that REM-related sleep apnea predicts poor adherence to PAP therapy, suggesting personalized strategies may improve outcomes.

## Contribution

Identifies REM-related OSA as a novel independent predictor of PAP therapy nonadherence.

## Key findings

- Rapid eye movement–related OSA was significantly more common in nonadherent patients.
- REM-related OSA was the only independent predictor of nonadherence (adjusted odds ratio 2.52).
- Sleep stage-specific phenotyping may help personalize adherence strategies.

## Abstract

To identify polysomnographic predictors of adherence to positive airway pressure (PAP) therapy in adults with obstructive sleep apnea (OSA).

We performed a retrospective cohort study of adults with moderate to severe OSA who underwent full-night diagnostic polysomnography and initiated PAP therapy. Participants with previous PAP titration studies were excluded. Baseline demographic and polysomnographic variables were extracted, and adherence was defined as PAP use ≥ 4 h/night on ≥ 70% of nights. Logistic regression identified factors independently associated with adherence.

Among 100 enrolled patients, 61 met the adherence criteria. Compared with adherent patients, nonadherent patients did not differ in apnea–hypopnea index, oxygen desaturation index, lowest oxygen saturation, or low arousal threshold. Rapid eye movement–related OSA was significantly more prevalent in the nonadherent group and was the only independent predictor of nonadherence (adjusted odds ratio, 2.52; 95% confidence interval, 1.04–6.22; p = 0.033).

Rapid eye movement–related OSA was the only independent predictor of poor adherence to PAP therapy. Sleep stage–specific phenotyping may therefore assist in personalizing adherence-enhancing strategies. Prospective studies are warranted to validate these findings and evaluate targeted interventions.