Analysis of Discontinuation Factors in Obstructive Sleep Apnea Patients with Positive Airway Pressure Therapy for a Long Time under the National Health Insurance Coverage

Background and Objectives: Positive airway pressure (PAP) is the treatment of choice for patients with obstructive sleep apnea (OSA). Although PAP is effective in resolving upper airway collapse, a major challenge is maximizing compliance. The purpose of this study was to investigate discontinuing factors in OSA patients with PAP therapy for a long time under the National Health Insurance coverage. Materials and Methods: A total of 229 patients, who were prescribed PAP between July 2018 and July 2020 were recruited and reviewed retrospectively. They were allocated to continue or discontinue group according to duration of PAP usage after 90 days compliance assessment. The discontinuing factors of PAP therapy between two groups were compared. Results: Among 229 patients, 49 failed to PAP therapy during adaptation period. One hundred and eighty patients constituted the final study population and the total good compliance rate at 90 days was 78.6%. The Kaplan-Meier curves showed PAP compliance continues to decrease by 13 months and remains thereafter. PAP-related problem was the major discontinuing factor in less than 13 months and other medical diseases in more than 13 months. Even in the group of continuous use of PAP, patients with low compliance often complained of PAP-related problem. Conclusion: Patients discontinuing PAP therapy within 13 months often have PAP-related problems. Therefore, early identification and rapid troubleshooting of difficulties with PAP use after adaptation period may underlie the higher long-term compliance.