Risk factors for non-compliance with continuous positive airway pressure therapy in patients with obstructive sleep apnea and paroxysmal atrial fibrillation

Patients diagnosed with obstructive sleep apnea (OSA) in cardiovascular clinics more often have difficulties with continuous positive airway pressure (CPAP) adherence, because they are minimally symptomatic. Aim of this study was to find risk factors for CPAP non-compliance in patients with AF. We prospectively studied 154 patients with paroxysmal AF and OSA (apnea-hypopnea-index (AHI)≥15/h), during CPAP tolerability test. Compliance was defined as usage>4 hours/night. The Epworth Sleepiness Scale (ESS) was used to investigate the degree of sleepiness (score 0-24). The Atrial Fibrillation Severity Scale (AFSS) assessed the burden and symptoms of AF, and the Short Form-36 (SF-36) obtained the quality of life. Body composition data were collected using a bioelectric impedance weight. Lung function (forced vital capacity (FVC)) was measured by spirometry. The study included 33 women (21%) and 121 men (79%). Mean age was 62.6±7.2 years while mean body mass index (BMI) was 29.4±4.3 kg/m². The median AHI was 22.8 (17.6-32.3). Of the cohort 115 (75%) were CPAP compliant, while 39 (25%) were non-compliant. Non-compliant patients had significantly higher alcohol consumption and higher FVC. We found no association between CPAP compliance and age, sex, BMI, body fat%, neck-and waist circumference, quality of life, AFSS symptom score and ESS. In multivariate analysis only higher FVC, AFSS burden and a lower AHI remained significant independent risk factors of non-compliance. Our study has shown that independent risk factors of non-compliance were higher FVC and AFSS burden, while higher AHI was associated with better compliance.