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Can personality characteristics improve CPAP adherence?
The standard treatment for moderate to severe Obstructive Sleep Apnea (OSA) is Continuous Positive Airway Pressure (CPAP), but so far, its use has often been associated with low compliance rates. This limiting factor reduces the efficiency of the treatment. Depression is associated with low adherence to CPAP, in addition to personality characteristics such as neuroticism.
We aimed to identify the association between individual factors (personality, depression, anxiety) and the CPAP adherence (defined as >4 h/night on 70% of nights) in male with moderate to severe OSA.
We selected 29 patients with BMI ≤35kg/m2, aged 35-65 years and diagnosed by complete laboratory polysomnography with moderate to severe OSA (apnea-hypopnea index – AHI ≥20 events/hour of sleep) and indication of CPAP. The following questionnaires were applied at the first visit of treatment: BIG 5 Inventory, Beck Depression Inventory and State-Trait Anxiety Inventory (STAI). The objective time of use (adherence) was achieved through a memory card located in the CPAP that records the number of minutes per night that the device was turned on with the mask in the ideal place. The time of subjective use was declared by the patient at the time of the visit to the clinic.
The 29 patients had a mean age of 48.6 ± 9 years. The emotional stability factor (BIG-5) was positively associated with the variable perception of CPAP use (β=0.179, 95% CI = 0.059-0.298, p=0.003). The total IDATE-Trait score was positively associated with the objective use of CPAP (β= 0.069, 95% CI = 0.026 – 0.111, p=0.002). However, the total BDI score did not show a significant association with the perception of subjective use of CPAP (p=0.95) and not even with the objective use of CPAP (p=0.067).
Emotional stability seems to be a significant factor for the subjective assessment of CPAP use. Nevertheless, anxiety as an individual trait was associated with better CPAP adherence. Personality factors must be considered to improve adherence to CPAP treatment.
Obstructive sleep apnea, CPAP adherence, personality factors, anxiety, depression.
Glaury Coelho, Priscila Tempaku, Erika Trepkow, Sergio Tufik, Lia Rita Bittencourt