Abstract
Background and Objectives: Although numerous studies have explored various predictors of positive airway pressure (PAP) adherence, the potential impact of objective sleep scoring data obtained during PAP titration on adherence has not been thoroughly investigated. The objective of this study was to evaluate the association between objective sleep parameters obtained from PAP titration, including sleep efficiency (SE), wake after sleep onset (WASO), and sleep latency (SL), and short-term PAP adherence in individuals with obstructive sleep apnea (OSA). Materials and Methods: A total of 227 individuals with a confirmed diagnosis of OSA underwent overnight PAP titration and were subsequently divided into adherence and non-adherence groups. Baseline demographic characteristics, clinical data, diagnostic polysomnography results, and PAP titration data were obtained for all subjects. Paired sample t-tests were utilized to assess differences in sleep parameters between diagnostic polysomnography and PAP titration within each group. Binomial logistic regression was used to evaluate the predictive value of changes in SE, WASO, and SL for PAP adherence and to determine optimal cut-off values. A χ(2) analysis was conducted to assess the relationship between categorical improvements in SE and WASO and adherence to PAP therapy. Results: Among the study cohort, 176 (77.5%) participants were classified as adherent, while 51 (22.5%) participants were classified as non-adherent. SE during PAP titration (83.3 ± 12.6%) was significantly higher compared to baseline polysomnography (80.9 ± 12.4%, p = 0.020), and WASO was significantly reduced (63.9 ± 58.9 min vs. 77.7 ± 67.2 min, p = 0.016). No significant difference was observed in SL between the two groups. Logistic regression analysis indicated that increased SE (odds ratio [OR]: 1.025, p = 0.039) and decreased WASO (OR: 0.994, p = 0.027) both served as significant predictors of PAP adherence, but the overall predictive ability of these indicators was modest (area under the curve 0.60 for SE; 0.62 for WASO). The optimal thresholds distinguishing adherence were ΔSE ≥ 2.39% and ΔWASO < -1.5 min. Participants who exhibited improvements in SE (χ(2) = 5.296, p = 0.021) and WASO (χ(2) = 6.877, p = 0.009) demonstrated a significantly higher likelihood of adhering to PAP therapy. Conclusions: The findings demonstrate that objective increases in sleep quality, specifically elevated SE and decreased WASO during initial PAP titration, are significantly associated with short-term PAP adherence among patients with OSA.