CPAP Adherence Predictors in a Randomized Trial Author Q&A with Anna May, MD, MS

By: Vanessa Claude

September 21, 2018

1. What effects do you hope the findings of this study will have on future clinical trials and treatment adherence?

This study found that CPAP study arm assignment, increasing age, and early adherence is associated with higher long-term adherence. Recent studies of positive airway pressure have suffered from suboptimal participant adherence with interventions. Crossover (a participant randomized to the active treatment arm not adhering to treatment) and incomplete blinding are threats to the internal validity of randomized controlled trials. We hope this study spurs clinical research to evaluate and improve on the current standard for sham CPAP. More aggressive monitoring and intervention in the first week may also improve participant adherence for each study arm.

2. How would you overcome some of the limitations of this study to move forward? What are some factors that could enhance this study further?

The population from this study was from a single-center randomized controlled trail which evaluated CPAP over 8 weeks. Prospective planning for an analysis of adherence in a longer term (3-6 month) multicenter randomized controlled trial would allow for validation of findings. A larger sample size would allow for a better powered study designed to detect subtle differences in clinically important adherence predictors.

3. Are there any findings that you’d like to expand on in the future? And what results would you like to find?

Sex- and race-specific treatment effects are well-known. This study found sex and race-specific differences in factors affecting long-term adherence. Evaluation for sex-and race-specific CPAP treatment effects may help personalize obstructive sleep apnea therapy recommendations in the clinical setting.

Read the full article: CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities

Anna M. May, MD, MS, is a staff physician at the Sleep Medicine Section at the Louis Stokes Cleveland VA Medical Center. Her research focuses on positive airway pressure therapy adherence in obstructive sleep apnea and the cardiovascular effects of periodic limb movements during sleep.