| Comparison of Early and Late Dropout Factors in Positive Airway Pressure Therapy for Obstructive Sleep Apnea |
Jong Kwan Kim
, Myoung Su Choi
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| Department of Otolaryngology-Head and Neck Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea |
| 폐쇄성 수면무호흡증 양압기 치료에서 조기 및 후기 탈락 요인의 비교 |
| 김종관
, 최명수
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| 을지대학교 의과대학 대전을지대학교병원 이비인후과학교실 |
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Received: 18 May 2026; Revised: June 24, 2026 Accepted: 6 July 2026. Published online: 4 August 2026. |
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| ABSTRACT |
Background and Objectives
Positive airway pressure (PAP) therapy is the gold-standard treatment for obstructive sleep apnea (OSA), yet a substantial proportion of patients discontinue treatment, with underlying causes potentially differing by dropout timing. This study aimed to compare clinical characteristics, polysomnography (PSG) findings, and reasons between early dropouts (ED; ≤3 months) and late dropouts (LD; >3 months), and to identify factors associated with dropout timing.
Subjects and Method
This retrospective study included 106 OSA patients who discontinued PAP therapy (ED, n=62; LD, n=44), classified by the Korean National Health Insurance 3-month adherence evaluation cutoff. Dropout causes were extracted from structured nursing records and categorized into four mechanistic domains.
Results
Baseline demographics and PSG parameters were compared between groups. Device discomfort (52.5% vs. 14.0%, p<0.001) and expiratory pressure resistance (22.6% vs. 0%, p<0.001) predominated in ED, whereas lack of perceived treatment effect (8.2% vs. 44.2%, p<0.001) and lack of disease awareness (1.6% vs. 15.9%, p=0.008) characterized LD. The Firth’s penalized logistic regression indicated that device discomfort was independently associated with ED (penalized odds ratio=3.65, 95% confidence interval: 1.34-9.99, p=0.012).
Conclusion
PAP dropout mechanisms differ qualitatively by timing. ED is driven by device-related physiological barriers, suggesting that early-phase management should prioritize device adaptation and pressure optimization, while long-term retention requires disease awareness reinforcement and objective efficacy feedback. |
| Keywords:
Adherenceㆍ Expiratory pressure intoleranceㆍ Obstructive sleep apneaㆍ Positive airway pressure |
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