Comparison of Early and Late Dropout Factors in Positive Airway Pressure Therapy for Obstructive Sleep Apnea

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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.

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