Research Article
CPAP Treatment Adherence in Women with
Obstructive Sleep Apnea
E. Libman,
1,2
S. Bailes,
1,2
C. S. Fichten,
1,2,3
D. Rizzo,
1,4
L. Creti,
1,2
M. Baltzan,
2,5,6
R. Grad,
1,2
A. Pavilanis,
2,7
D.-L. Tran,
1,4
K. Conrod,
1
and R. Amsel
2
1
Jewish General Hospital, Montreal, QC, Canada
2
McGill University, Montreal, QC, Canada
3
Dawson College, Montreal, QC, Canada
4
Universit´ e de Montr´ eal, Montreal, QC, Canada
5
Mount Sinai Hospital Centre, Montreal, QC, Canada
6
OSR Medical, Montreal, QC, Canada
7
St. Mary’s Hospital Centre, Montreal, QC, Canada
Correspondence should be addressed to E. Libman; eva.libman@mcgill.ca
Received 15 November 2016; Accepted 29 January 2017; Published 2 March 2017
Academic Editor: Yuan-Yang Lai
Copyright © 2017 E. Libman et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Untreated obstructive sleep apnea (OSA) has numerous negative health-related consequences. Continuous positive airway pressure
(CPAP) is generally considered the treatment of choice for OSA, but rates of nonadherence are high. It is believed that OSA is more
prevalent among men; therefore understanding how OSA presents among women is limited and treatment adherence has received
little research attention. For this study, 29 women were recruited from primary care ofces. Tey completed a questionnaire battery
and underwent a night of nocturnal polysomnography (PSG) followed by a visit with a sleep specialist. Women diagnosed with OSA
were prescribed CPAP; 2 years later CPAP adherence was evaluated. Results show that approximately half the sample was adherent.
Tere were no signifcant diferences between adherent and nonadherent women on OSA severity; however CPAP adherent women
had worse nocturnal and daytime functioning scores at the time of diagnosis. Moreover, when the seven nocturnal and daytime
variables were used as predictors in a discriminant analysis, they could predict 87% of adherent and 93% of the nonadherent women.
Te single most important predictor was nonrefreshing sleep. We discuss the implications of the fndings for identifying women in
primary care with potential OSA and ofer suggestions for enhancing treatment adherence.
1. Introduction
Obstructive sleep apnea (OSA) is a chronic disorder of the
upper respiratory system characterized by repetitive collapse
of the upper airway during sleep. Tis results in hypoxemia,
increased sympathetic overdrive, increased blood pressure,
and increased carbon dioxide levels in the blood; the resulting
hypoxia is linked to a wide range of problems stemming
from oxidative stress and infammation and is associated
with multiple cardiovascular morbidities, as well as coronary
artery-related and all-cause mortality [1–14]. OSA is closely
related to the metabolic syndrome, which includes obesity,
hyperlipidemia, hypertension, and diabetes; the nature of
these and OSA may be bidirectional [8].
Estimated prevalence of OSA in the adult population
is high, although estimates vary widely according to the
sample and diagnostic threshold selected. For example, in a
general population sample of 40- to 65-year-old Icelanders,
Arnardottir and colleagues found an overall prevalence of
43%, with difering frequencies when participants were char-
acterized as mild, moderate, or severe OSA [15]. Similarly,
in a systematic review, Senaratna and colleagues reported an
overall population prevalence of between 9% and 38% for
very mild OSA; prevalence and severity increased with age to
reach 90% in some elderly groups, with a higher prevalence in
men [16]. Te higher male to female ratio has been refected in
other studies, roughly two to one. For example, reported OSA
prevalence in the general American population was 23.4%
Hindawi
Sleep Disorders
Volume 2017, Article ID 2760650, 8 pages
https://doi.org/10.1155/2017/2760650