| Patient related factors | | Failure to understand the importance of the therapy. | | Failure to understand instructions concerning the therapy. | | Concomitant self-administration of prescription or nonprescription medications or alcohol. | | Social isolation, thus lack of social support. (Patients with supportive families have been shown to be more compliant with prescription drugs - data not available for CPAP use.) | | Feeling ill, or being too tired to use the therapy. | | Physical limitations, including vision, hearing, hand coordination. | | Poor self-efficacy. | | Younger age. | | African-American. | | Lower socioeconomic status. | | Moderate to severe obstructive sleep apnea. | | Lack of bed partner engagement. | | Less severe oxyhemoglobin desaturation during sleep. | | Small nasal volume. | | Co-morbid insomnia. | | | Therapy and medication related factors | | Complexity of therapy, in device use, or medication dosing. | | Increased rate of adverse reactions. (Device use has complications, and the provider needs to meet with the patient periodically to determine adverse events and help address these issues.) | | Characteristics of illness; long-term or chronic illnesses are a problem, as compliance decreases over time. | | Expensive therapy (only a problem when a patient must pay out of pocket or has not met the deductible). | | Lack of efficacy (higher residual apnea-hypopnea index). | | Less than 4 hours of CPAP nightly use in first 2 weeks. | | Problems on first night of use. | | | Health professional related factors | | Poor relationship with patient. | | Expression of doubt concerning therapeutic potential. | | Unwillingness to educate patients. | | Lack of knowledge of medications the patient is taking or has access to. (Sedatives and alcohol can compound OSA, and their use should be evaluated.) | |
