Can Sleep Hypoxic Measures Predict Long-Term Adherence to Positive Airway Pressure Treatments?

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by recurrent upper airway collapse. Continuous positive airway pressure (CPAP) is the gold standard treatment but is burdened by low adherence rates. Nighttime hypoxia may alter sleep structure and OSA symptoms, potentially affecting PAP treatment adherence. This study aims to evaluate whether nocturnal hypoxia measures could predict long-term PAP adherence. We conducted a real-life, retrospective study including 207 OSA patients. Clinical data were collected on symptoms, comorbidities, home sleep apnea test (HSAT) metrics, prescribed therapy and objective adherence data via in-built device software. Nocturnal respiratory failure (NRF) was defined as a total sleep time with SpO2 < 90% (TST90) ≥ 30%. Among the cohort, 119 patients met the criteria for NRF. These patients exhibited higher BMI, more severe OSA and a higher prevalence of COPD compared to those without NRF. At follow-up, patients with NRF demonstrated significantly better treatment adherence and more frequently reported improvement in several daytime and nighttime symptoms. Time-to-event analysis and adjusted multivariable regressions showed a higher probability of good long-term PAP adherence in patients with TST90 ≥ 30%. These findings suggest that prolonged nocturnal hypoxemia may identify a subgroup of patients more likely to maintain long-term PAP treatment.