- 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.
- Higher residual AHI.
- Lack of bed partner engagement.
- Less severe oxyhemoglobin desaturation during sleep.
- Small nasal volume.
- Comorbid insomnia.
| - 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 AHI).
- Less than 4 hours of CPAP nightly use in first 2 weeks.
- Problems on first night of use.
| - 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 (eg, sedatives and alcohol can compound OSA, and their use should be evaluated).
- Lack of knowledge regarding OSA or positive airway therapy to adequately counsel patients.
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