Factors affecting compliance in CPAP device usage for obstructive sleep apnea: a mixed-methods study integrating quantitative and qualitative findings.

backgroundThis study aims to identify novel factors influencing adherence to Continuous Positive Airway Pressure (CPAP) devices, the primary treatment for obstructive sleep apnea (OSA), and to compile the most comprehensive list of variables in the literature.

methodsA mixed-methods approach was adopted, analyzing patient records from a sleep center between 2018 and July 1, 2023. Quantitative data were obtained from surveys administered to 449 patients, while qualitative data were collected through in-depth interviews with 30 patients and document reviews of 449 records. Analyses were conducted using FACTORY Analysis, SmartPLS, IBM SPSS, and MAXQDA software.

resultsThe combined analysis of quantitative and qualitative findings identified previously unreported variables affecting CPAP adherence. A comprehensive list of influencing factors was developed, spanning device/accessory-related, psychosocial, environmental, individual, regional, and political domains. Eight novel variables were uncovered, including barriers such as fear of lightning/thunder, fear of earthquakes, relocation, religious practices, air pollution, and long hair, as well as facilitators like the use of automatic devices and rural residency. These findings indicate that existing theories and models are insufficient to fully explain CPAP adherence, highlighting the complexity of the process.

conclusionThis study highlights the complexity of CPAP adherence and calls for new theoretical models. It highlights the importance of geographical, cultural, and religious influences, advocating for further research to address these gaps and improve patient adherence strategies. CLINICAL TRIAL NUMBER: Not applicable.