# Effect of aromatic stimulation on CPAP adherence and sleep quality in patients with obstructive sleep apnea: a pilot study

## TL;DR

This pilot study explores whether using lavender or cypress aromas can improve CPAP adherence and sleep quality in patients with obstructive sleep apnea.

## Contribution

The study introduces aromatic stimulation as a novel, noninvasive method to enhance CPAP adherence and sleep outcomes in OSA patients.

## Key findings

- Median PSQI scores improved significantly after 67 days of aromatic stimulation.
- CPAP usage duration increased from 149 to 231 minutes per night following the intervention.
- Exposure to essential oils was associated with improved adherence and subjective sleep quality.

## Abstract

Continuous positive airway pressure (CPAP) therapy remains the cornerstone of obstructive sleep apnea (OSA) treatment, considerably reducing the risk of cardiovascular complications and improving patient outcomes. However, adherence to CPAP therapy is a major challenge and poor compliance limits its efficacy. This study investigated the potential of aromatherapy, a noninvasive, cost-effective intervention, to improve CPAP adherence and enhance sleep quality in patients with OSA.

A prospective observational pilot study was conducted in patients with obstructive sleep apnea who demonstrated poor CPAP adherence (< 70% usage and < 4 h/night). Participants were exposed to lavender or cypress aroma oil during sleep. Pre- and post-intervention subjective sleep measures Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and objective CPAP usage metrics were collected. Normally distributed variables were analyzed using paired t-tests, and non-normally distributed variables were analyzed using the Wilcoxon signed-rank test. Statistical significance was set at p < 0.05. A post hoc power analysis was performed based on observed effect sizes for the primary outcomes.

Eight patients with OSA (mean age 53.5 years; 4 males, 4 females) participated in the study. Following 67 days of treatment, the median PSQI score significantly improved from 9.0 to 6.5 (p = 0.006), and the median ESS score decreased from 9.0 to 6.5 (p = 0.034). Additionally, CPAP for more than 4 h increased from 5.0% to 25.7% (p = 0.028). The median usage duration improved from 149 to 231 min (p = 0.018). No significant change in apnea hypopnea index (AHI) was observed during CPAP use, decreasing from 3.2 events/h to 1.3 events/h (p = 0.226), which is consistent with the understanding that appropriately applied CPAP maintains effective control of respiratory events.

Aromatic stimulation with essential oils shows promise in improving both CPAP adherence and sleep quality, offering a novel approach to enhance OSA treatment efficacy.