Patients’ experiences of barriers and facilitators with continuous positive airway pressure therapy in obstructive sleep apnoea – a qualitative interview study

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Untreated obstructive sleep apnoea is associated with cardiovascular disease, diabetes, traffic accidents, and decreased quality of life. Continuous positive airway pressure (CPAP) therapy is the gold standard for treating obstructive sleep apnoea. However, only approximately half of all treated patients succeed with this therapy. There is a lack of knowledge about the patient experience of CPAP treatment and the barriers and facilitators to successful CPAP treatment. The study aimed to explore how newly diagnosed patients with OSA experience receiving the diagnosis, their motivation for treatment, and essential factors for successful CPAP treatment. Methods: A qualitative design using individual semi-structured interviews was applied. Patients with successful (n=10) and unsuccessful (n=9) treatment were interviewed. Qualitative Content Analysis inspired by Graneheim and Lundman was used. Results: The analysis derived five themes: “Symptoms and thoughts about the diagnosis and CPAP treatment”, “Expectations and personal resources are important for success”, “The experience of problems and benefit from CPAP treatment”, “Social impact of CPAP treatment” and “Information and support from the sleep clinic.” Conclusions: Newly diagnosed patients with obstructive sleep apnoea describe barriers to successful CPAP treatment as lack of support from their partner and problems with the equipment. Important facilitators are positive expectations, partner support, and noticeable treatment effects. Early follow-up support, a biopsychosocial approach, and relatives' involvement in the sleep clinic consultations are needed to support patients toward successful CPAP treatment. CPAP apnoea-hypopnoea index semi-structured adherence sleep clinic qualitative content analysis Contributions to the literature Studies have indicated that the experience of continuous positive airway pressure (CPAP) therapy poses a significant burden on individuals with obstructive sleep apnoea (OSA). Newly diagnosed patients with OSA describe barriers to successful CPAP treatment as lack of support from their partner and problems with the equipment, regardless of their adherence level. Important facilitators are an open attitude, positive expectations, partner support, and noticeable treatment effect. Background Obstructive sleep apnoea (OSA) is an increasingly common condition, with repetitive pharyngeal collapse during sleep ( 1 ). The prevalence ranges from 6–17% in the general adult population ( 2 , 3 ), making OSA one of the most frequent diseases ( 4 ). In Denmark, approximately 1,7% of the population is diagnosed with OSA ( 5 ), which indicates under diagnosis problems. Untreated OSA can lead to a significantly increased risk of morbidity and mortality ( 6 , 7 ), and OSA is more likely to co-occur with obesity, structural abnormalities, diabetes, and cardiovascular diseases ( 8 , 9 ). The main symptoms of OSA are daytime sleepiness and fatigue, which can cause decreased quality of life, impaired cognitive function, increased risk of traffic accidents, and systemic hypertension ( 10 , 11 ). The diagnosis of OSA can be determined by a home sleep apnoea test, resulting in a apnoea-hypopnoea index (AHI). An AHI 30 as severe OSA ( 12 ). Positive Airway Pressure (PAP or CPAP for Continuous) therapy is the primary treatment for patients with moderate to severe OSA ( 13 ). If used consistently, CPAP is an effective treatment, but there is often limited and variable adherence among patients ( 14 , 15 ). The level of adherence is a measure of the patient’s consistent use of CPAP and is calculated based on how many hours the CPAP treatment is used in a given period. High adherence is defined as “use of CPAP treatment regularly for more than 4 hours/night for > 70% of the recorded period ( 16 ). Low adherence is defined as using CPAP for less than 4 hours/night for less than 70% of the nights in a given period. Non adherence refers to CPAP not being used in a given period. Studies report that 10–78% of patients achieve high adherence after initiating CPAP treatment. Thus, a large number of patients with OSA do not achieve successful CPAP treatment. However, the long-term adherence of CPAP is not well described ( 17 – 19 ). Knowledge about the reasons behind variable short-term adherence and factors affecting long-term adherence from a user perspective is important for supporting patients in successful therapy. Qualitative studies have found that CPAP treatment is experienced as a significant burden for patients with OSA ( 20 – 22 ). In 2021, a systematic review and thematic synthesis was published on patient experiences of using PAP for OSA ( 23 ). The analysis generated four themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Their findings highlight the applicability of a biopsychosocial understanding of PAP use. As a limitation, they found that many of the included studies only recruited current PAP users and potentially reduced the inclusion of more difficult experiences of PAP treatment ( 23 ). There is thus a need to gain insight into the patient’s experiences earlier in the process to improve support from healthcare professionals, increase the number of high-adherence patients, and achieve knowledge on patients' experiences using PAP where PAP treatment is not yet established and successful. Cultural differences may affect clinical practice as well as the experience of PAP treatment, and only one of the studies was from Scandinavia ( 24 ). Furthermore, only six of the included twenty-five studies were published during the past six years (2017–2019 ( 23 )). A scoping review investigating motivational interventions to improve CPAP adherence ( 25 ) found that motivational interventions were more effective compared to standard care despite the results not always being maintained over time. The authors recommend conducting qualitative studies investigating what type of information and strategies patients perceive as most meaningful. Such information could contribute to optimising motivational interventions for improved patient outcomes. Aim This study aimed to explore newly diagnosed patients with OSA's experience of 1) receiving an OSA diagnosis, 2) motivation for CPAP treatment, and 3) essential factors to succeed with CPAP treatment, including support from a sleep clinic. Methods Study design We planned a qualitative study based on a hermeneutic approach using individual semi-structured interviews ( 26 , 27 ). Setting and participants The study was performed at the sleep clinic at Sygehus Sønderjylland, University Hospital of Southern Denmark in Sønderborg, Denmark. Patients diagnosed with sleep apnoea from a sleep registration (either in primary care or through the sleep clinic) evaluate their daytime sleepiness on the Epworth Sleepiness Scale (ESS). The ESS provides a sum score ranging from 0 to 24; the higher the score, the higher the person’s level of daytime sleepiness ( 28 , 29 ). The patients attend a medical examination at the sleep clinic to determine whether CPAP treatment should be initiated. If treatment is initiated, the patient receives CPAP equipment and guidance from an experienced sleep apnoea nurse. After six to eight weeks, the patient meets for a follow-up consultation with an experienced nurse. All patients are offered follow-up appointments. Treatment is adjusted for patients with low or non adherence, and a shorter follow-up is scheduled. Nurses in the sleep clinic acted as gatekeepers. The nurses informed eligible participants verbally about the study and offered written information. If, after time for consideration, the patients wished to participate, they provided written signed consent and arranged an appointment with the study nurse for an interview. The nurses invited ten patients with no or low adherence at the second consultation and ten patients with high adherence. To achieve varied information, we used stratified sampling to capture and provide information about experiences regarding CPAP treatment in the participants’ everyday lives. We aimed for maximum variation regarding age, sex, marital status (living alone or cohabitant), comorbidities, body mass index and level of adherence to ensure different perspectives ( 30 ). Participants who did not speak or understand Danish were excluded. We used Malterud’s concept of information power to reflect on and guide the sample size ( 31 ). Data collection An interview guide was developed based on the study aim, experiences of nurses and physicians at the sleep clinic and input from two patient research partners. Please see Table 1 for the overall themes in the interview guide. Table 1 – Interview guide Themes Follow-up questions The diagnosis of sleep apnoea What were you referred for? How did you experience receiving the diagnosis? What thoughts did you have about your future everyday life with sleep apnoea? Handover of the CPAP machine What did you already know about CPAP? What were your expectations for CPAP treatment? How did you experience the handover of the CPAP machine? What feelings did you have afterward? Use of the CPAP machine What challenges did you experience initially, and now after some time of use? What do you think is important for whether or not it is successful to use a CPAP machine? Assistance from others for CPAP treatment Do you have contact with others with sleep apnoea? Do you receive help/support for CPAP treatment from them? Has anyone reacted negatively to your CPAP treatment? Has anyone made a special difference for you in your sleep experience? Quality of life - the experience of life before treatment and now What has CPAP treatment meant for you? Do you experience its impact on your sexual/intimate life? How did you sleep before starting CPAP treatment? How do you sleep now? Lifestyle changes, group dispensing, mentorship, and check-ups Would you be interested in further assistance with lifestyle changes? Would you be interested in group dispensing of the CPAP machine and a mentorship program? What benefits do you see with both in-person and telemedicine check-ups? Three sleep apnoea specialist nurses from the sleep clinic at Sønderborg Hospital performed semi-structured individual interviews with the participants. Each nurse did not interview participants with whom they had had a professional relationship from the clinic. Depending on the patient’s preferences, the interviews could be performed by telephone, online through Teams, or face-to-face in a quiet room at the sleep clinic. All interviews were recorded. Secretaries from the Sleep clinic transcribed the interviews using a transcription guide to ensure consistency. Analysis To describe the manifest and interpret the latent content of the transcribed empirical material, we used qualitative content analysis, as described by Graneheim and Lundman ( 26 ). Table 2 describes the steps in the analysis, and Table 3 provides examples of the analysis process. Table 2 – The steps in the qualitative content analysis Step Description 1 Read all the transcribed interviews several times to capture a sense of the complete data material 2 Identify meaning units of importance to the aims of the study 3 Condense and code the identified meaning units on the manifest level on post-it notes including participant numbers. Adherent participants on a yellow post-it and non-adherent participants on red post-it notes. 4 Compare codes based on similarities and differences, and sort the codes into categories on wall posters describing the manifest content across all interviews 5 Based on the interpretation of codes and categories, overall themes are developed and described. Table 3 – Example of the analysis process from meaning units to themes Meaning unit Condensed meaning unit Code Category Theme I am happy to speak about CPAP and there are more people than you realize that also have the device Speaks openly about CPAP treatment Openness to CPAP treatment Openness and tabu Symptoms and thoughts about the diagnosis and CPAP treatment I had no idea what I was getting into, but it was enough to stop snoring as much and get a more peaceful sleep No specific expectations, but expected less snoring and improved sleep Expected less snoring and improved sleep Expectations for CPAP treatment Expectations and personal resources are important for success My mask is simply so noisy. We've talked about sleeping separately, but we haven’t yet. We keep trying. Mask-related problems can result in the need for a separate bedroom. Noise from the mask leads to the need to sleep separately The mask has an impact on the relationship. Social impact of CPAP treatment Ethical considerations Data collection and management was registered under the Danish Data Protection Agency at Sygehus Sønderjylland, University Hospital of Southern Denmark (Journal nr.: 22/41839). We obtained written consent from the participants and data was stored at Sygehus Sønderjyllands internal T-drive, which complies with the European General Data Protection Regulation and Danish law for data protection. The Regional Scientific Ethical Committees in The Region of Southern Denmark decided no formal approval was needed in accordance with Danish law as it was not a biomedical study (Journal nr.: S-2022000-104). No names, details, or sensitive information are reported to ensure confidentiality and conceal the participants’ identities. Results We included ten adherent and nine non-adherent participants. Table 4 reports socio-economic and disease-specific information for the participants. The interviews were conducted by telephone from September 2022 to November 2022. None of the interviews were conducted online or face-to-face. Table 4 – Demographic and clinical characteristics of participants Adherent participants Age (years) Sex Adherence to CPAP AHI before start of CPAP ESS BMI Civil status Work situation 70–74 F 80–89% Severe 8 18,5–24,9 Co-habitant Retired 45–49 M 80–89% Moderate 6 > 30 Co-habitant Full-time 70–74 M 80–89% Severe 12 25–29,9 Co-habitant Retired 50–54 F 90–100% Severe 4 - Single Full-time 45–49 F 80–89% Severe 10 > 30 Single Part-time 65–69 M 90–100% Moderate 3 25–29,9 Co-habitant Retired 60–64 F 90–100% Moderate 4 25–29,9 Co-habitant Full-time 35–39 M 70–79% Moderate 8 25–29,9 Co-habitant Full-time 35–39 F 80–89% Severe 11 > 30 Co-habitant Full-time 65–69 M 80–89% Moderate 5 18,5–24,9 Co-habitant Retired Non- or low-adherent participants 30–34 M 0–9% Severe 17 > 30 Co-habitant Full-time 70–74 M 0–9% Moderate 7 25–29,9 Co-habitant Retired 60–64 M 30–39% Severe 12 25–29,9 Co-habitant Full-time 45–49 F 30–39% Mild 4 25–29,9 Co-habitant Retired 45–49 M 30–39% Severe NA 25–29,9 Co-habitant Full-time 60–64 M 10–19% Mild 17 25–29,9 Co-habitant Full-time 60–64 M 50–59% Severe 9 25–29,9 Co-habitant Full-time 45–49 M 50–59% Severe 2 25–29,9 Co-habitant Full-time 60–65 M 30–39% Severe 13 > 30 Co-habitant Retired F : Female; M : Male; CPAP : Continuous Positive Airway Pressure; AHI : Apnoea-hypopnoea index 30 severe; BMI : Body Mass Index 30 severe overweight; ESS : Epworth Sleepiness Scale ranging from 0 to 24, the higher the score, the higher the person’s level of daytime sleepiness; NA : Not Available The analysis derived five themes: “Symptoms and thoughts about the diagnosis and CPAP treatment, “Expectations and personal resources are important for success”, “The experience of problems and benefit from CPAP treatment”, “Social impact of CPAP treatment” and “Information and support from the sleep clinic”. In the following, each theme is described in more detail and illustrated by selected quotes. Symptoms and thoughts about the diagnosis and CPAP treatment Participants described frustrations and worries after being diagnosed with OSA and before starting CPAP treatment. “It sounded extremely dangerous despite feeling like you actually had an okay life” (male 60–64 years – low/non-adherent) “I associated sleep apnoea with elderly overweight men, so it was tough mentally” (male 30–34 years – adherent) However, many participants were happy to receive a diagnosis, as they learned about the reason for their current symptoms and the treatment options. It was also important for them to reduce the risks of untreated sleep apnoea. “I was disappointed about the disease or diagnosis, but something could be done - I could come home with a solution under my arm” (male 45–47 years – adherent) Some participants who had prior knowledge about OSA from family, friends, colleagues, and the media reported fewer frustrations/worries before treatment. “Not really worried because I already knew a little about it from my former boss and my brother” (male 60–64 years – low/non-adherent) The most frequent symptoms the participants described that led to diagnosis were fatigue, snoring, and breathing problems. In addition, participants had been diagnosed with OSA due to lack of energy and decreased memory - often women. Participants referred for evaluation of sleep apnoea due to snoring or breathing problems were almost all men. The participants described how a partner or others had noticed snoring and/or breathing problems. However, some participants had experienced waking up with feelings of not being able to breathe. For others, partners were alerted and nervous about the lack of breathing and were disturbed by the loud snoring. “I snore, and my wife was nervous about my lack of breathing at night” (male 70–74 years – low/non-adherent) “I couldn't sleep with other people because I felt like I annoyed them with my snoring” (male 30–34 years – low/non-adherent) In addition to fatigue, snoring, and breathing pauses, several participants also described other symptoms that led to evaluation for OSA, such as headache, heart disease, and the feeling of “heavy eyelids”. Expectations and personal resources are important for success The participants described how their expectations and personal resources affected their motivation for treatment. The patients had positive but varying expectations for the treatment and its effect. However, a general expectation was that their fatigue and snoring would be treated/reduced. This expectation was a significant motivation for starting with CPAP. Several participants felt that the prospect of their symptoms and comorbidities either improving or ceasing was an important motivating factor. “If sleep apnoea has an impact on my blood pressure and CPAP can make me reduce my medication, that would be a good thing” (male 60–64 years - low/non-adherent) Some male participants described the importance of attitude and openness to ensure CPAP treatment success. Others described that the greatest motivation was feeling the effect of the CPAP treatment and experiencing a positive change in their daily lives. Many of the participants from both groups reported that support and conversations about CPAP treatment with their relatives, employers, and social circle positively affected their motivation for the treatment. In addition, some were motivated as CPAP treatment changed the symptoms and thus their concerns about the partner/family. “I think it's (swear word) more or less done for my wife's sake, so she could get some proper sleep” (male 45–49 years - low/non-adherent) Some participants described how starting CPAP treatment was a big adjustment since they could not sleep well with the equipment every night, and some nights not at all. In addition, they felt it was demotivating to continue the treatment. “I expected to feel more rested and fresh during the day. The first night was really good, and I was so refreshed during the day. The second night was bad; I was frustrated and upset, it went up and down” (female 35–39 years - adherent) Only one participant expressed no knowledge about CPAP treatment or support from a social network. However, several participants also described feelings of insecurity. They found it challenging with many new practical issues and worries. “Info is difficult because there are so many new things you're dealing with and new feelings about how it's going to go if you can handle it by yourself and things like that” (male 45–49 years - adherent) The experience of problems and benefits from CPAP treatment It was difficult for the participants to get used to the CPAP treatment. Some needed several months of adjustment, partly due to problems with falling asleep, interrupted sleep, discomfort from mask/tube, gas in the stomach, dryness in the nose/mouth/throat, heat, and feelings of suffocation. “For the first few months, I would wake up and press the on/off button [to reset the regulation of pressure], and it took a while before I fell asleep again. Now I give it [the button] a tap, and then I fall asleep again” (female 45–49 years - low/non-adherent) Some described quickly experiencing better sleep, feeling more rested, and noticing a difference after the first night of treatment. These participants reported improved quality of life after initiating CPAP treatment. “Certainly a little more complicated to fall asleep, but if it makes me feel better in the end, then that's just what it is” (male 35–39 years - adherent) Mask problems were initially a major issue for most participants, resulting in mask changes. Many found it challenging to choose the most suitable mask because they were unfamiliar with the range available and whether they needed a nasal or full-face mask. Likewise, they lacked knowledge about what it was like to sleep with a mask on at night. They doubted whether a mask was appropriately fitted, as they had had nothing with which to compare. Mask leakage was one of the predominant complaints. The causes were, among other things, facial hair and lack of experience in adjusting the mask. “It “farts” when you sweat and blow up your eyes” (female 45–49 years – adherent) This resulted in sores on the bridge of the nose, noise and leakage, limited sleeping positions, and restless and interrupted sleep. Several male participants, but none of the female participants, described their partners being bothered by the sound and air from the mask. Many of the participants experienced positive effects of CPAP treatment, such as more restful sleep, fewer nocturnal toilet visits, increased energy in daily life, increased desire for physical activity, better memory, and a sense of a better quality of life. Some also reported that CPAP treatment had reduced several of their other symptoms, such as headaches/migraines, restless legs, snoring, and fatigue. “I feel like the light bulb has been fully plugged in now (female 45–49 years - adherent) After starting CPAP, I have not had any headaches. If I couldn't feel an effect, I wouldn't have slept with it” (female 45–49 years - adherent) A group of participants also felt that CPAP treatment had little or no effect. They described unchanged or increased fatigue. Despite this, none expressed a desire to discontinue CPAP treatment. Several attributed their motivation to continue due to their knowledge about the consequences of untreated OSA. “The motivation is the risks of untreated sleep apnoea because I‘m a little disappointed with the effect on my fatigue” (male 65–69 years - adherent) Despite describing the minimal treatment effect, some reported that their partners experienced the opposite: more energy in the participant. Social impact of CPAP treatment Many participants reported that CPAP treatment positively impacted their relationship with their partner. For example, they could now sleep together again as snoring was no longer a disturbance, and their evening energy levels were higher. “Now I can sleep with my wife again, something I haven't been able to do for almost 1.5 years due to snoring” (male 60–64 years - low/non-adherent) Other participants described the treatment as mentally challenging, affecting intimacy. They felt restricted in physical contact and closeness. “It's tough. I don't put on the mask until the lights are out. I don't want to lie close to my husband with the mask on, I don't want him to come near me when I have it on” (female 35–39 years – adherent) Other participants described limitations with other relatives to CPAP treatment, as the mask was perceived as scary for children or grandchildren. Some participants with no partner described having doubts about introducing the CPAP machine to a future partner. “New partner - I don't think it makes the chances better, but I also think that I used to snore a lot, which wasn't nice. This is a better alternative” (male 30–34 years – low/non-adherent) Some participants expressed feeling the diagnosis of OSA and CPAP treatment was taboo. “It's nice that there were others who knew about it, but I would also like to keep it to myself - I don't think it's anyone else's business what diseases I have or don't have” (male 30–34 years – low/non-adherent) Almost all participants with good adherence described being open about their CPAP treatment with their family and friends. In the participants with low/non-adherence, openness about CPAP treatment was more varied. About half did not want or did not feel the need to talk to their family/friends about CPAP treatment. Some saw challenges in staying overnight outside and/or with others. “I'm going to a summer house with some friends who don't know I have sleep apnoea - I'm already thinking about it” (female 35–39 years – adherent) Information and support from the sleep clinic The participants shared their experiences from the first visits to the sleep clinic regarding the professional support and information they had received and future ways of using support to succeed with the CPAP treatment. Generally, the participants assessed that the information they received at the clinic was sufficient and informative during medical and nursing consultations. Some described that it provided reassurance, while others emphasised the nurse's and doctor's ability to be positive, answer relevant questions, make practical suggestions, and take time for the individual, such as demonstrating sleep data on a PC screen and providing visual demonstrations by the doctor of the anatomy of the throat. All of the above factors impacted the initiation of treatment. Topics not addressed during the initial conversation but important to participants included the long-term aim for CPAP treatment and the consequences of untreated sleep apnoea. Some participants wished they had received more information about how difficult it could be to adjust to CPAP treatment. Others were unsure if they had received the desired information or had forgotten it, such as about comorbidities, driver's license regulations, cleaning, mask selection, adherence requirements, and tele-monitoring. “Ordering equipment and changing filters, it's definitely not information that has stuck with me if I have been told about it” (male 60–64 years, low/non-adherent) Despite the valuable information, many found the situation overwhelming, and some described that they could not process more information. Other critical comments included feeling that the consultation with the doctor was too fast and that they were just a number in a queue. Many of the participants were positive about the possibility of group consultations but not necessarily keen to participate themselves. Likewise, the participants had widely different desires for the composition of such a group. Some wanted to meet others of the same age and gender, so they were with like-minded people. Others thought the challenge would be the same whether they were 20 or 60 years old, in the workforce or not. However, everyone agreed that the group size should not exceed six people. “Groups would not make a difference to me, of course, there may be some questions from other patients that you haven't thought of yourself” (male 65–69 years - adherent) Participants with good adherence said they did not want or feel the need to participate in groups. Reasons included that it would be crossing a boundary, fear of not being heard or appearing dumb, keeping intimate questions to themselves, and exposing themselves. “No one will ask dumb questions, no one will attract attention, no one will appear dumb, no one will ask embarrassing questions, no one will say what do I do when I want to have sex” (female 50–54 years - adherent) In the first period after initiation of CPAP treatment, the participants were positive about telephone and email contact with the Sleep clinic, where it was easy for them to get in touch and receive quick responses. Many participants described these communication channels as a "lifeline" combined with the information from the distributed brochures. “Ordering [ CPAP spare parts ] is simply top grade, I call the sleep clinic, and then I have it in my mailbox just as quick as the Postal Service could manage” (male 65–69 years - adherent) At the follow-up check after 6–8 weeks, participants were satisfied with the opportunity to refresh healthcare information, ask additional questions after treatment initiation, and have the machine and mask reviewed again. Participants described these as factors that impacted whether treatment succeeded. In general, most participants preferred physical consultations compared to virtual/phone contacts as they felt they would get more out of seeing and discussing their development in treatment sitting across from a healthcare professional rather than on a screen. Participants preferring virtual check-ins highlighted the benefits of avoiding the drive and taking time off work. However, virtual contact was only considered relevant when the treatment worked and there were no problems to discuss and only if the patients still had an opportunity to come into the sleep clinic in case of problems. “Attendance is definitely an advantage, I had some things that needed adjusting, I want to see and hear the people I need to explain it to” (male 45–49 years - adherent) Despite no specific questions during the interview, several participants focused on the need for other treatment options to CPAP. In particular, they inquired about treatment with dental appliances, weight loss, and possible surgery. “Of course, I had hoped that I could just have surgery, but that was not the case” (male 30–34 years, low/non-adherent) Discussion This study aimed to explore newly diagnosed patients with OSA's experience of 1) receiving an OSA diagnosis, 2) motivation for CPAP treatment, and 3) essential factors to succeed with CPAP treatment, including support from a sleep clinic. The patients experienced frustration, concern, hope, and relief when receiving the OSA diagnosis. Initially, motivation for treatment was good for most, as they hoped their OSA symptoms and the risk of comorbidities would be reduced. Both the adherent and low/non-adherent groups of participants agreed that the most important facilitators for successful CPAP treatment were an open attitude, positive expectations, noticeable treatment effects, and support from family and the sleep clinic. A common issue across the derived themes was motivation. Participants described knowledge of the OSA disease, expectations of treatment, and risks of comorbidities with untreated OSA as motivating factors for ensuring treatment worked. Therefore, it is important to address these issues early in the treatment process to optimise the motivational interventions for improved patient outcomes ( 25 ). Participants who experienced an effect of CPAP treatment, such as less fatigue, became even more motivated to ensure CPAP treatment was successful. Conversely, participants who did not immediately experience the effect of treatment had a more challenging time finding the motivation to become "friends" with the CPAP device. Practical challenges such as problems with the mask, hose, and machine could also contribute to lower motivation, as seen in a previous qualitative study ( 32 ). To obtain support in case of practical challenges, patients need easy access to help from a sleep clinic, such as through phone or online contact. For participants, it was imperative to have support from their partner, and many described how the CPAP device affected their relationship, and for some, it had some negative consequences. The role of spouses/partners in initiating patients' CPAP treatment has been described in previous studies ( 33 ) and investigated in a scoping review from 2022 ( 34 ), with 21 studies, of which five were qualitative ( 20 , 23 , 35 – 38 ). The review concluded that the support of the relatives, especially at the beginning of the treatment, is essential for the patient's use and motivation for CPAP treatment. The involvement of relatives will provide the relatives with a better foundation to support and motivate the patient and may help reduce possible concerns and resistance to the CPAP treatment. Furthermore, treatment of OSA with CPAP can have health benefits for spouses/partners too ( 39 ). Collaborative partner involvement may be a useful strategy for increasing CPAP adherence. Therefore, healthcare professionals could consider involving relatives at the start of treatment. For example, encouraging patients to include a relative at the first consultation in the sleep clinic and allowing the relatives' concerns and issues to be addressed in the consultation. If they cannot attend physically, it may be possible to give them online access if the patient agrees. Patients without relatives may need additional support from the sleep clinic staff to ensure adherence. Despite participants reporting that they feel well-informed about the treatment, several indicated that they would have liked more information about the length of the adaptation period. Others suggested that an extensive amount of information should not be given simultaneously. Health literacy is the ability to read, understand, critically appraise, and use health-related information ( 40 ). A Danish study found that between 14.5% and 18.3% of adults find it challenging to follow health instructions, ensure that healthcare providers understand their problems correctly, and feel unable to discuss their health concerns with healthcare providers ( 41 ). A patient’s health literacy level is associated with self-management ability in chronic diseases ( 42 ). Thus, we expect that low health literacy will also affect the ability to succeed with CPAP treatment among patients with OSA. Sleep clinics could consider splitting the information session in half and providing video podcasts and written information as supplements. In addition, it may be relevant to plan earlier follow-up support after initiation of treatment, i.e. after two weeks so that the patient can report start-up problems and treatment can be adjusted before the problems grow too big. This follow-up could be virtual ( 43 ) unless patients are experiencing problems with the mask and need another type. Follow-up support should target the patient's health literacy level to reduce the number of patients with low or no adherence. The difference in participants' attitudes towards attendance or virtual check-ups reflects the need for more individually tailored follow-up, too. Our expectation for the study was that the group's experiences with good adherence would differ from those with poor adherence. However, there were surprisingly many similarities in their experiences and thoughts about the OSA diagnosis and starting CPAP treatment. However, there was a clear tendency for participants with good adherence to be open about their illness, whereas participants in the non-adherence group were often more closed and/or did not think others should be involved. This observation also expresses the enormous taboo that still exists in society about OSA, which some participants described as a social burden. The reason for poor adherence to CPAP in patients with OSA is multifactorial ( 44 ). Thus, it is important that we, as healthcare professionals, address the whole patient, not just the practical management of the CPAP device and the biomedical aspects. As described in a previous study, a biopsychosocial understanding is needed. There should be opportunities to discuss the psychosocial factors that can constitute barriers to treatment success with the health professionals ( 23 ). This includes the patient’s feelings about diagnosis, partner’s attitude and reactions, openness about the treatment, concerns related to CPAP treatment, and feelings if treatment fails. It should also involve information about where and how the patient can receive support when facing problems. Strengths and limitations One of the strengths of this study is that the participants include patients who have successfully started CPAP treatment and participants who found it problematic and did not achieve high adherence. In addition, we included participants of different ages, relationship statuses, comorbidities, and body mass index, so the interviewed group reflects the population we see daily in the sleep clinic. Furthermore, it is a strength that the author group consists of doctors and nurses with extensive knowledge in the field and nurses and researchers from other specialties, so data was not only interpreted from a discipline-specific perspective. Finally, we assessed that we had achieved sufficient "information power" with 19 participants. There was not much new information in the last 2–3 interviews, but it may be a limitation that there was only one woman in the low adherence group despite striving for similar variety in sex between groups. Perspectives This study has helped us gain knowledge about the barriers that patients struggle with in their daily lives to make the treatment successful, and the clinical opportunities to include psychosocial areas in the dialogue, tailor the information to the individual participant's needs and health literacy level, and develop follow-up support options for patients with low or non-adherence. Future studies could explore whether implementing a biopsychosocial approach, involvement of relatives and different approaches to information and follow-up can contribute to successful CPAP treatment for more patients. We found that family members significantly impacted participants' motivation, and future studies could consider examining the group of non-adherent patients and their motivation concerning whether they have a supportive partner, a partner who dislikes the CPAP device, or perhaps no family member who can support their treatment. In these cases, healthcare providers may offer special follow-up care to this specific patient group. Conclusions When receiving an OSA diagnosis, patients experience frustration, concern, hope, and relief. Initially, their motivation for treatment is good, as they hope that their OSA symptoms and the risk of comorbidities will be reduced. Regardless of adherence level, patients with OSA describe barriers to successful CPAP treatment as lack of support from their partner and problems with the mask, hose, or machine. The most important facilitators for successful CPAP treatment are positive expectations, personal resources, an open attitude to tell others about the treatment, noticeable treatment effects, and support from family, the broader social network, and the sleep clinic. Early follow-up support, a biopsychosocial approach, and relatives' involvement in the sleep clinic consultations are needed to support more patients toward successful CPAP treatment. Abbreviations BMI, body mass index CPAP, continuous positive airway pressure ESS, Epworth sleepiness scale OSA, obstructive sleep apnoea PAP, positive airway pressure AHI, apnoea-hypopnoea index Declarations Ethics approval and consent to participate: The Regional Scientific Ethical Committees in The Region of Southern Denmark decided no formal approval was needed in accordance with Danish law as it was not a biomedical study (Journal nr.: S-2022000-104). Consent for publication: We obtained written consent from the participants. No names, details, or sensitive information are reported to ensure confidentiality and conceal the participants’ identities. Availability of data and materials: The datasets generated and analysed during the current study are not publicly available in accordance with Danish law and due to personal information in the interviews. Data are available from the corresponding author on reasonable request. Competing interests: The authors declare no conflict of interest. Funding: We received funding from the Danish Life Science Cluster – Region of Southern Denmark. Authors’ contributions: All authors collaborated on the study’s design. ARG, IDD and MBJ interviewed the participants. The analysis and discussion of the findings were conducted by the entire author team. KJ, ARG, IDD and MBJ drafted the initial version, and JP provided critical revisions to the paper. All authors have reviewed and approved the final manuscript. Acknowledgements: We thank all the patients who participated in the interviews and the two patient research partners for their input to the interview guide. Also, thank you to Caroline Margaret Moos for linguistic revisions. References Malhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002;360(9328):237-45. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39. Jennum PJ, Larsen P, Cerqueira C, Schmidt T, Tønnesen P. The Danish National Database for Obstructive Sleep Apnea. Clin Epidemiol. 2016;8:573-6. Jennum P, Ibsen R, Kjellberg J. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax. 2013;68(10):949-54. Jennum P, Tønnesen P, Ibsen R, Kjellberg J. Obstructive sleep apnea: effect of comorbidities and positive airway pressure on all-cause mortality. Sleep Med. 2017;36:62-6. Jennum P, Ibsen R, Kjellberg J. Morbidity prior to a diagnosis of sleep-disordered breathing: a controlled national study. J Clin Sleep Med. 2013;9(2):103-8. Salari N, Khazaie H, Abolfathi M, Ghasemi H, Shabani S, Rasoulpoor S, et al. The effect of obstructive sleep apnea on the increased risk of cardiovascular disease: a systematic review and meta-analysis. Neurol Sci. 2021. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-47. Udholm N, Rex CE, Fuglsang M, Lundbye-Christensen S, Bille J, Udholm S. Obstructive sleep apnea and road traffic accidents: a Danish nationwide cohort study. Sleep Med. 2022;96:64-9. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med. 2019;15(2):301-34. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15(6):343-56. Chen YF, Hang LW, Huang CS, Liang SJ, Chung WS. Polysomnographic predictors of persistent continuous positive airway pressure adherence in patients with moderate and severe obstructive sleep apnea. Kaohsiung J Med Sci. 2015;31(2):83-9. Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147(4):887-95. Al-Abri MA, Al-Harmeli A, Al-Habsi M, Jaju D. Acceptance and Compliance of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea: Local Population Survey. Oman Med J. 2020;35(6):e198. Jacobsen AR, Eriksen F, Hansen RW, Erlandsen M, Thorup L, Damgård MB, et al. Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. PLoS One. 2017;12(12):e0189614. Yi H, Shang S, Zhang Y, Zhang C, Xu L, Wang J, et al. Study on adherence to positive airway pressure treatment for patients with obstructive sleep apnea using real-world big data in a telemedicine management system. Methods. 2022;204:92-100. Luyster FS, Dunbar-Jacob J, Aloia MS, Martire LM, Buysse DJ, Strollo PJ. Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis. Behav Sleep Med. 2016;14(1):67-84. Chou MSH, Ting NCH, El-Turk N, Harrington Z, Dobler CC. Treatment burden experienced by patients with obstructive sleep apnoea using continuous positive airway pressure therapy. PLoS One. 2021;16(6):e0252915. Almeida FR, Henrich N, Marra C, Lynd LD, Lowe AA, Tsuda H, et al. Patient preferences and experiences of CPAP and oral appliances for the treatment of obstructive sleep apnea: a qualitative analysis. Sleep Breath. 2013;17(2):659-66. Brown A, Jones S, Perez-Algorta G. Experiences of using positive airway pressure for treatment of obstructive sleep apnea: a systematic review and thematic synthesis. Sleep. 2021;44(10). Møkleby M, Mengshoel AM. Devoted or negotiated routes of adherence: Narratives of patients with obstructive sleep apnoea using a continuous positive airway pressure device. Nurs Open. 2019;6(3):1237-44. Rapelli G, Pietrabissa G, Manzoni GM, Bastoni I, Scarpina F, Tovaglieri I, et al. Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front Psychol. 2021;12:705364. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12. Green J, Thorogood N. Qualitative methods for health research. 4th ed. Los Angeles: SAGE; 2018. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5. Kendzerska TB, Smith PM, Brignardello-Petersen R, Leung RS, Tomlinson GA. Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review. Sleep Med Rev. 2014;18(4):321-31. Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999;34(5 Pt 2):1189-208. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753-60. Aalaei S, Rezaeitalab F, Tabesh H, Amini M, Afsharisaleh L, Mostafavi SM, et al. Factors Affecting Patients' Adherence to Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea Disorder: A Multi-Method Approach. Iran J Med Sci. 2020;45(3):170-8. Ward K, Hoare KJ, Gott M. What is known about the experiences of using CPAP for OSA from the users' perspective? A systematic integrative literature review. Sleep Med Rev. 2014;18(4):357-66. Rosa D, Amigoni C, Rimoldi E, Ripa P, Ligorio A, Fracchiolla M, et al. Obstructive Sleep Apnea and Adherence to Continuous Positive Airway Pressure (CPAP) Treatment: Let's Talk about Partners! Healthcare (Basel). 2022;10(5). Ye L, Antonelli MT, Willis DG, Kayser K, Malhotra A, Patel SR. Couples' experiences with continuous positive airway pressure treatment: a dyadic perspective. Sleep Health. 2017;3(5):362-7. Elfström M, Karlsson S, Nilsen P, Fridlund B, Svanborg E, Broström A. Decisive situations affecting partners' support to continuous positive airway pressure-treated patients with obstructive sleep apnea syndrome: a critical incident technique analysis of the initial treatment phase. J Cardiovasc Nurs. 2012;27(3):228-39. Gibson R, Campbell A, Mather S, Neill A. From diagnosis to long-term management: the experiences of older New Zealanders with obstructive sleep apnoea. J Prim Health Care. 2018;10(2):140-9. Ward KG, M. Hoare, K. Making choices about CPAP: Findings from a grounded theory study about living with CPAP. Collegian. 2018;25(1):81-8. Luyster FS. Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review. J Clin Sleep Med. 2017;13(3):467-77. Maindal HV-J, K. Health Literacy – Theory, Research and Practice2016; Vol. 30:[p. 3-16. pp.]. Bo A, Friis K, Osborne RH, Maindal HT. National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults. BMC Public Health. 2014;14:1095. Mackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making. 2016;36(6):741-59. Alsaif SS, Kelly JL, Little S, Pinnock H, Morrell MJ, Polkey MI, et al. Virtual consultations for patients with obstructive sleep apnoea: a systematic review and meta-analysis. Eur Respir Rev. 2022;31(166). Broström A, Nilsen P, Johansson P, Ulander M, Strömberg A, Svanborg E, et al. Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: a qualitative content analysis. Sleep Med. 2010;11(2):126-30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Jun, 2025 Read the published version in Archives of Public Health → Version 1 posted Editorial decision: Revision requested 03 Apr, 2025 Reviews received at journal 02 Apr, 2025 Reviewers agreed at journal 02 Apr, 2025 Reviews received at journal 14 Jun, 2024 Reviewers agreed at journal 14 May, 2024 Reviewers invited by journal 13 May, 2024 Submission checks completed at journal 02 May, 2024 Editor assigned by journal 02 May, 2024 First submitted to journal 26 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4330546","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":298758536,"identity":"c0c72271-8f89-46fd-9912-565250624ef4","order_by":0,"name":"Karin Jeppesen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBACCSA+wMDABuPbgAgDBp4DxGtJI04LMjhMWItk+9mHhwsY+OTMpZsPf/i443y+/IzkDQxvzuDWIs2TbnB4BgObseWcY2mSM8/cttxwI62Acc4N3FrkgK4/zMPAlrjhRo4ZM2/bbQMDiRwDZp4PeLTwPwNrqd9wI//z579t5wzkZxDQIi0BsSXB4EYOgzRj2wEDhhsgLXgcJjkDZIsBm+HOOcfMJHvbkg0MzjwrODgHj/clzqcxf+apOCYPDLHHH3622RnItydvfPDmGG4tEGBwjMEAHkMCCaDIJQhqkLTwE6NhFIyCUTAKRhIAAM8aUxj6wtWFAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Southern Denmark","correspondingAuthor":true,"prefix":"","firstName":"Karin","middleName":"","lastName":"Jeppesen","suffix":""},{"id":298758537,"identity":"235d180e-0f14-44a8-ae81-bea9f198cd38","order_by":1,"name":"Anita Rabøl Good","email":"","orcid":"","institution":"Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Anita","middleName":"Rabøl","lastName":"Good","suffix":""},{"id":298758539,"identity":"973e4199-015e-42d6-b2fa-cb6e35551028","order_by":2,"name":"Ilse Dall Dyrhaug","email":"","orcid":"","institution":"Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Ilse","middleName":"Dall","lastName":"Dyrhaug","suffix":""},{"id":298758541,"identity":"665f2b20-4cf8-477f-994d-5db5c26c3f68","order_by":3,"name":"Marianne Bruun Johansen","email":"","orcid":"","institution":"Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Marianne","middleName":"Bruun","lastName":"Johansen","suffix":""},{"id":298758543,"identity":"584f2de8-aef2-4c0a-9f0e-5fd7f80ca231","order_by":4,"name":"Jette Primdahl","email":"","orcid":"","institution":"Department of Regional Health Research, University of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Jette","middleName":"","lastName":"Primdahl","suffix":""}],"badges":[],"createdAt":"2024-04-26 15:36:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4330546/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4330546/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13690-025-01645-w","type":"published","date":"2025-06-16T15:57:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85231313,"identity":"669bf01f-5f5f-4efd-b543-e2e7b7b9e342","added_by":"auto","created_at":"2025-06-23 16:05:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":976091,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4330546/v1/1d9bd870-1c9c-4c34-aed4-c307ba970781.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patients’ experiences of barriers and facilitators with continuous positive airway pressure therapy in obstructive sleep apnoea – a qualitative interview study","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003eStudies have indicated that the experience of continuous positive airway pressure (CPAP) therapy poses a significant burden on individuals with obstructive sleep apnoea (OSA).\u003c/li\u003e\n \u003cli\u003eNewly diagnosed patients with OSA describe barriers to successful CPAP treatment as lack of support from their partner and problems with the equipment, regardless of their adherence level.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eImportant facilitators are an open attitude, positive expectations, partner support, and noticeable treatment effect.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Background","content":"\u003cp\u003eObstructive sleep apnoea (OSA) is an increasingly common condition, with repetitive pharyngeal collapse during sleep (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The prevalence ranges from 6\u0026ndash;17% in the general adult population (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), making OSA one of the most frequent diseases (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In Denmark, approximately 1,7% of the population is diagnosed with OSA (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), which indicates under diagnosis problems. Untreated OSA can lead to a significantly increased risk of morbidity and mortality (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and OSA is more likely to co-occur with obesity, structural abnormalities, diabetes, and cardiovascular diseases (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The main symptoms of OSA are daytime sleepiness and fatigue, which can cause decreased quality of life, impaired cognitive function, increased risk of traffic accidents, and systemic hypertension (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe diagnosis of OSA can be determined by a home sleep apnoea test, resulting in a apnoea-hypopnoea index (AHI). An AHI\u0026thinsp;\u0026lt;\u0026thinsp;5 is considered normal. AHI of 5\u0026ndash;15 is considered mild, AHI of 15\u0026ndash;30 as moderate, and AHI\u0026thinsp;\u0026gt;\u0026thinsp;30 as severe OSA (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Positive Airway Pressure (PAP or CPAP for Continuous) therapy is the primary treatment for patients with moderate to severe OSA (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). If used consistently, CPAP is an effective treatment, but there is often limited and variable adherence among patients (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The level of adherence is a measure of the patient\u0026rsquo;s consistent use of CPAP and is calculated based on how many hours the CPAP treatment is used in a given period. High adherence is defined as \u0026ldquo;use of CPAP treatment regularly for more than 4 hours/night for \u0026gt;\u0026thinsp;70% of the recorded period (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Low adherence is defined as using CPAP for less than 4 hours/night for less than 70% of the nights in a given period. Non adherence refers to CPAP not being used in a given period. Studies report that 10\u0026ndash;78% of patients achieve high adherence after initiating CPAP treatment. Thus, a large number of patients with OSA do not achieve successful CPAP treatment. However, the long-term adherence of CPAP is not well described (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKnowledge about the reasons behind variable short-term adherence and factors affecting long-term adherence from a user perspective is important for supporting patients in successful therapy.\u003c/p\u003e \u003cp\u003eQualitative studies have found that CPAP treatment is experienced as a significant burden for patients with OSA (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In 2021, a systematic review and thematic synthesis was published on patient experiences of using PAP for OSA (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The analysis generated four themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Their findings highlight the applicability of a biopsychosocial understanding of PAP use. As a limitation, they found that many of the included studies only recruited current PAP users and potentially reduced the inclusion of more difficult experiences of PAP treatment (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). There is thus a need to gain insight into the patient\u0026rsquo;s experiences earlier in the process to improve support from healthcare professionals, increase the number of high-adherence patients, and achieve knowledge on patients' experiences using PAP where PAP treatment is not yet established and successful. Cultural differences may affect clinical practice as well as the experience of PAP treatment, and only one of the studies was from Scandinavia (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Furthermore, only six of the included twenty-five studies were published during the past six years (2017\u0026ndash;2019 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)).\u003c/p\u003e \u003cp\u003eA scoping review investigating motivational interventions to improve CPAP adherence (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) found that motivational interventions were more effective compared to standard care despite the results not always being maintained over time. The authors recommend conducting qualitative studies investigating what type of information and strategies patients perceive as most meaningful. Such information could contribute to optimising motivational interventions for improved patient outcomes.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study aimed to explore newly diagnosed patients with OSA's experience of 1) receiving an OSA diagnosis, 2) motivation for CPAP treatment, and 3) essential factors to succeed with CPAP treatment, including support from a sleep clinic.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design\u003c/h2\u003e\n \u003cp\u003eWe planned a qualitative study based on a hermeneutic approach using individual semi-structured interviews (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eSetting and participants\u003c/h2\u003e\n \u003cp\u003eThe study was performed at the sleep clinic at Sygehus S\u0026oslash;nderjylland, University Hospital of Southern Denmark in S\u0026oslash;nderborg, Denmark.\u003c/p\u003e\n \u003cp\u003ePatients diagnosed with sleep apnoea from a sleep registration (either in primary care or through the sleep clinic) evaluate their daytime sleepiness on the Epworth Sleepiness Scale (ESS). The ESS provides a sum score ranging from 0 to 24; the higher the score, the higher the person\u0026rsquo;s level of daytime sleepiness (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). The patients attend a medical examination at the sleep clinic to determine whether CPAP treatment should be initiated. If treatment is initiated, the patient receives CPAP equipment and guidance from an experienced sleep apnoea nurse. After six to eight weeks, the patient meets for a follow-up consultation with an experienced nurse. All patients are offered follow-up appointments. Treatment is adjusted for patients with low or non adherence, and a shorter follow-up is scheduled.\u003c/p\u003e\n \u003cp\u003eNurses in the sleep clinic acted as gatekeepers. The nurses informed eligible participants verbally about the study and offered written information. If, after time for consideration, the patients wished to participate, they provided written signed consent and arranged an appointment with the study nurse for an interview. The nurses invited ten patients with no or low adherence at the second consultation and ten patients with high adherence. To achieve varied information, we used stratified sampling to capture and provide information about experiences regarding CPAP treatment in the participants\u0026rsquo; everyday lives. We aimed for maximum variation regarding age, sex, marital status (living alone or cohabitant), comorbidities, body mass index and level of adherence to ensure different perspectives (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). Participants who did not speak or understand Danish were excluded. We used Malterud\u0026rsquo;s concept of information power to reflect on and guide the sample size (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection\u003c/h2\u003e\n \u003cp\u003eAn interview guide was developed based on the study aim, experiences of nurses and physicians at the sleep clinic and input from two patient research partners. Please see Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e for the overall themes in the interview guide.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u0026ndash; Interview guide\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eThemes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFollow-up questions\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe diagnosis of sleep apnoea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat were you referred for?\u003c/p\u003e\n \u003cp\u003eHow did you experience receiving the diagnosis?\u003c/p\u003e\n \u003cp\u003eWhat thoughts did you have about your future everyday life with sleep apnoea?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHandover of the CPAP machine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat did you already know about CPAP?\u003c/p\u003e\n \u003cp\u003eWhat were your expectations for CPAP treatment?\u003c/p\u003e\n \u003cp\u003eHow did you experience the handover of the CPAP machine?\u003c/p\u003e\n \u003cp\u003eWhat feelings did you have afterward?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUse of the CPAP machine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat challenges did you experience initially, and now after some time of use?\u003c/p\u003e\n \u003cp\u003eWhat do you think is important for whether or not it is successful to use a CPAP machine?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssistance from others for CPAP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you have contact with others with sleep apnoea?\u003c/p\u003e\n \u003cp\u003eDo you receive help/support for CPAP treatment from them?\u003c/p\u003e\n \u003cp\u003eHas anyone reacted negatively to your CPAP treatment?\u003c/p\u003e\n \u003cp\u003eHas anyone made a special difference for you in your sleep experience?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQuality of life - the experience of life before treatment and now\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat has CPAP treatment meant for you?\u003c/p\u003e\n \u003cp\u003eDo you experience its impact on your sexual/intimate life?\u003c/p\u003e\n \u003cp\u003eHow did you sleep before starting CPAP treatment?\u003c/p\u003e\n \u003cp\u003eHow do you sleep now?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLifestyle changes, group dispensing, mentorship, and check-ups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould you be interested in further assistance with lifestyle changes?\u003c/p\u003e\n \u003cp\u003eWould you be interested in group dispensing of the CPAP machine and a mentorship program? What benefits do you see with both in-person and telemedicine check-ups?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eThree sleep apnoea specialist nurses from the sleep clinic at S\u0026oslash;nderborg Hospital performed semi-structured individual interviews with the participants. Each nurse did not interview participants with whom they had had a professional relationship from the clinic. Depending on the patient\u0026rsquo;s preferences, the interviews could be performed by telephone, online through Teams, or face-to-face in a quiet room at the sleep clinic.\u003c/p\u003e\n \u003cp\u003eAll interviews were recorded. Secretaries from the Sleep clinic transcribed the interviews using a transcription guide to ensure consistency.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eAnalysis\u003c/h2\u003e\n \u003cp\u003eTo describe the manifest and interpret the latent content of the transcribed empirical material, we used qualitative content analysis, as described by Graneheim and Lundman (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e). Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e describes the steps in the analysis, and Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e provides examples of the analysis process.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2 \u0026ndash; The steps in the qualitative content analysis\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.280373831775702%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.7196261682243%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.280373831775702%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.7196261682243%\" valign=\"top\"\u003e\n \u003cp\u003eRead all the transcribed interviews several times to capture a sense of the complete data material\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.280373831775702%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.7196261682243%\" valign=\"top\"\u003e\n \u003cp\u003eIdentify meaning units of importance to the aims of the study\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.280373831775702%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.7196261682243%\" valign=\"top\"\u003e\n \u003cp\u003eCondense and code the identified meaning units on the manifest level on post-it notes including participant numbers. Adherent participants on a yellow post-it and non-adherent participants on red post-it notes.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.280373831775702%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.7196261682243%\" valign=\"top\"\u003e\n \u003cp\u003eCompare codes based on similarities and differences, and sort the codes into categories on wall posters describing the manifest content across all interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.280373831775702%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"89.7196261682243%\" valign=\"top\"\u003e\n \u003cp\u003eBased on the interpretation of codes and categories, overall themes are developed and described.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u0026ndash; Example of the analysis process from meaning units to themes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeaning unit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCondensed meaning unit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCode\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI am happy to speak about CPAP and there are more people than you realize that also have the device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpeaks openly about CPAP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpenness to CPAP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpenness and tabu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSymptoms and thoughts about the diagnosis and CPAP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI had no idea what I was getting into, but it was enough to stop snoring as much and get a more peaceful sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo specific expectations, but expected less snoring and improved sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExpected less snoring and improved sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExpectations for CPAP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExpectations and personal resources are important for success\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy mask is simply so noisy. We\u0026apos;ve talked about sleeping separately, but we haven\u0026rsquo;t yet. We keep trying.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMask-related problems can result in the need for a separate bedroom.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNoise from the mask leads to the need to sleep separately\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe mask has an impact on the relationship.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial impact of CPAP treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eEthical considerations\u003c/h2\u003e\n \u003cp\u003eData collection and management was registered under the Danish Data Protection Agency at Sygehus S\u0026oslash;nderjylland, University Hospital of Southern Denmark (Journal nr.: 22/41839). We obtained written consent from the participants and data was stored at Sygehus S\u0026oslash;nderjyllands internal T-drive, which complies with the European General Data Protection Regulation and Danish law for data protection. The Regional Scientific Ethical Committees in The Region of Southern Denmark decided no formal approval was needed in accordance with Danish law as it was not a biomedical study (Journal nr.: S-2022000-104). No names, details, or sensitive information are reported to ensure confidentiality and conceal the participants\u0026rsquo; identities.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe included ten adherent and nine non-adherent participants. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e reports socio-economic and disease-specific information for the participants. The interviews were conducted by telephone from September 2022 to November 2022. None of the interviews were conducted online or face-to-face.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Demographic and clinical characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdherent participants\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAdherence to CPAP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAHI before start of CPAP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eESS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eCivil status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eWork situation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u0026ndash;89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18,5\u0026ndash;24,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u0026ndash;89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u0026ndash;89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u0026ndash;100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u0026ndash;89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePart-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u0026ndash;100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u0026ndash;100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u0026ndash;79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u0026ndash;89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u0026ndash;89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18,5\u0026ndash;24,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNon- or low-adherent participants\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u0026ndash;39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u0026ndash;39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u0026ndash;39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026ndash;19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u0026ndash;29,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFull-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u0026ndash;39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-habitant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eF\u003c/span\u003e: Female; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eM\u003c/span\u003e: Male; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCPAP\u003c/span\u003e: Continuous Positive Airway Pressure; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAHI\u003c/span\u003e: Apnoea-hypopnoea index\u0026thinsp;\u0026lt;\u0026thinsp;5 normal, 5\u0026ndash;15 mild, 15\u0026ndash;30 moderate and \u0026gt;\u0026thinsp;30 severe; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBMI\u003c/span\u003e: Body Mass Index\u0026thinsp;\u0026lt;\u0026thinsp;18,5 underweight, 18,5\u0026ndash;24,9 normal, 25\u0026ndash;29,9 overweight and \u0026gt;\u0026thinsp;30 severe overweight; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eESS\u003c/span\u003e: Epworth Sleepiness Scale ranging from 0 to 24, the higher the score, the higher the person\u0026rsquo;s level of daytime sleepiness; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNA\u003c/span\u003e: Not Available\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe analysis derived five themes: \u0026ldquo;Symptoms and thoughts about the diagnosis and CPAP treatment, \u0026ldquo;Expectations and personal resources are important for success\u0026rdquo;, \u0026ldquo;The experience of problems and benefit from CPAP treatment\u0026rdquo;, \u0026ldquo;Social impact of CPAP treatment\u0026rdquo; and \u0026ldquo;Information and support from the sleep clinic\u0026rdquo;. In the following, each theme is described in more detail and illustrated by selected quotes.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSymptoms and thoughts about the diagnosis and CPAP treatment\u003c/h2\u003e \u003cp\u003eParticipants described frustrations and worries after being diagnosed with OSA and before starting CPAP treatment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It sounded extremely dangerous despite feeling like you actually had an okay life\u0026rdquo; (male 60\u0026ndash;64 years \u0026ndash; low/non-adherent)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I associated sleep apnoea with elderly overweight men, so it was tough mentally\u0026rdquo; (male 30\u0026ndash;34 years \u0026ndash; adherent)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, many participants were happy to receive a diagnosis, as they learned about the reason for their current symptoms and the treatment options. It was also important for them to reduce the risks of untreated sleep apnoea.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I was disappointed about the disease or diagnosis, but something could be done - I could come home with a solution under my arm\u0026rdquo; (male 45\u0026ndash;47 years \u0026ndash; adherent)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome participants who had prior knowledge about OSA from family, friends, colleagues, and the media reported fewer frustrations/worries before treatment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Not really worried because I already knew a little about it from my former boss and my brother\u0026rdquo; (male 60\u0026ndash;64 years \u0026ndash; low/non-adherent)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe most frequent symptoms the participants described that led to diagnosis were fatigue, snoring, and breathing problems. In addition, participants had been diagnosed with OSA due to lack of energy and decreased memory - often women. Participants referred for evaluation of sleep apnoea due to snoring or breathing problems were almost all men. The participants described how a partner or others had noticed snoring and/or breathing problems. However, some participants had experienced waking up with feelings of not being able to breathe. For others, partners were alerted and nervous about the lack of breathing and were disturbed by the loud snoring.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I snore, and my wife was nervous about my lack of breathing at night\u0026rdquo; (male 70\u0026ndash;74 years \u0026ndash; low/non-adherent)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I couldn't sleep with other people because I felt like I annoyed them with my snoring\u0026rdquo; (male 30\u0026ndash;34 years \u0026ndash; low/non-adherent)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn addition to fatigue, snoring, and breathing pauses, several participants also described other symptoms that led to evaluation for OSA, such as headache, heart disease, and the feeling of \u0026ldquo;heavy eyelids\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eExpectations and personal resources are important for success\u003c/h2\u003e \u003cp\u003e The participants described how their expectations and personal resources affected their motivation for treatment. The patients had positive but varying expectations for the treatment and its effect. However, a general expectation was that their fatigue and snoring would be treated/reduced. This expectation was a significant motivation for starting with CPAP.\u003c/p\u003e \u003cp\u003eSeveral participants felt that the prospect of their symptoms and comorbidities either improving or ceasing was an important motivating factor.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If sleep apnoea has an impact on my blood pressure and CPAP can make me reduce my medication, that would be a good thing\u0026rdquo; (male 60\u0026ndash;64 years - low/non-adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome male participants described the importance of attitude and openness to ensure CPAP treatment success. Others described that the greatest motivation was feeling the effect of the CPAP treatment and experiencing a positive change in their daily lives.\u003c/p\u003e \u003cp\u003eMany of the participants from both groups reported that support and conversations about CPAP treatment with their relatives, employers, and social circle positively affected their motivation for the treatment. In addition, some were motivated as CPAP treatment changed the symptoms and thus their concerns about the partner/family.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think it's (swear word) more or less done for my wife's sake, so she could get some proper sleep\u0026rdquo; (male 45\u0026ndash;49 years - low/non-adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome participants described how starting CPAP treatment was a big adjustment since they could not sleep well with the equipment every night, and some nights not at all. In addition, they felt it was demotivating to continue the treatment.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I expected to feel more rested and fresh during the day. The first night was really good, and I was so refreshed during the day. The second night was bad; I was frustrated and upset, it went up and down\u0026rdquo; (female 35\u0026ndash;39 years - adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOnly one participant expressed no knowledge about CPAP treatment or support from a social network. However, several participants also described feelings of insecurity. They found it challenging with many new practical issues and worries.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Info is difficult because there are so many new things you're dealing with and new feelings about how it's going to go if you can handle it by yourself and things like that\u0026rdquo; (male 45\u0026ndash;49 years - adherent)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe experience of problems and benefits from CPAP treatment\u003c/h2\u003e \u003cp\u003eIt was difficult for the participants to get used to the CPAP treatment. Some needed several months of adjustment, partly due to problems with falling asleep, interrupted sleep, discomfort from mask/tube, gas in the stomach, dryness in the nose/mouth/throat, heat, and feelings of suffocation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For the first few months, I would wake up and press the on/off button [to reset the regulation of pressure], and it took a while before I fell asleep again. Now I give it [the button] a tap, and then I fall asleep again\u0026rdquo; (female 45\u0026ndash;49 years - low/non-adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome described quickly experiencing better sleep, feeling more rested, and noticing a difference after the first night of treatment. These participants reported improved quality of life after initiating CPAP treatment.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Certainly a little more complicated to fall asleep, but if it makes me feel better in the end, then that's just what it is\u0026rdquo; (male 35\u0026ndash;39 years - adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMask problems were initially a major issue for most participants, resulting in mask changes. Many found it challenging to choose the most suitable mask because they were unfamiliar with the range available and whether they needed a nasal or full-face mask. Likewise, they lacked knowledge about what it was like to sleep with a mask on at night. They doubted whether a mask was appropriately fitted, as they had had nothing with which to compare. Mask leakage was one of the predominant complaints. The causes were, among other things, facial hair and lack of experience in adjusting the mask.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It \u0026ldquo;farts\u0026rdquo; when you sweat and blow up your eyes\u0026rdquo; (female 45\u0026ndash;49 years \u0026ndash; adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis resulted in sores on the bridge of the nose, noise and leakage, limited sleeping positions, and restless and interrupted sleep. Several male participants, but none of the female participants, described their partners being bothered by the sound and air from the mask.\u003c/p\u003e \u003cp\u003eMany of the participants experienced positive effects of CPAP treatment, such as more restful sleep, fewer nocturnal toilet visits, increased energy in daily life, increased desire for physical activity, better memory, and a sense of a better quality of life. Some also reported that CPAP treatment had reduced several of their other symptoms, such as headaches/migraines, restless legs, snoring, and fatigue.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I feel like the light bulb has been fully plugged in now (female 45\u0026ndash;49 years - adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAfter starting CPAP, I have not had any headaches. If I couldn't feel an effect, I wouldn't have slept with it\u0026rdquo; (female 45\u0026ndash;49 years - adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA group of participants also felt that CPAP treatment had little or no effect. They described unchanged or increased fatigue. Despite this, none expressed a desire to discontinue CPAP treatment. Several attributed their motivation to continue due to their knowledge about the consequences of untreated OSA.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The motivation is the risks of untreated sleep apnoea because I\u0026lsquo;m a little disappointed with the effect on my fatigue\u0026rdquo; (male 65\u0026ndash;69 years - adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Despite describing the minimal treatment effect, some reported that their partners experienced the opposite: more energy in the participant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocial impact of CPAP treatment\u003c/h2\u003e \u003cp\u003eMany participants reported that CPAP treatment positively impacted their relationship with their partner. For example, they could now sleep together again as snoring was no longer a disturbance, and their evening energy levels were higher.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Now I can sleep with my wife again, something I haven't been able to do for almost 1.5 years due to snoring\u0026rdquo; (male 60\u0026ndash;64 years - low/non-adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Other participants described the treatment as mentally challenging, affecting intimacy. They felt restricted in physical contact and closeness.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It's tough. I don't put on the mask until the lights are out. I don't want to lie close to my husband with the mask on, I don't want him to come near me when I have it on\u0026rdquo; (female 35\u0026ndash;39 years \u0026ndash; adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOther participants described limitations with other relatives to CPAP treatment, as the mask was perceived as scary for children or grandchildren.\u003c/p\u003e \u003cp\u003eSome participants with no partner described having doubts about introducing the CPAP machine to a future partner.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;New partner - I don't think it makes the chances better, but I also think that I used to snore a lot, which wasn't nice. This is a better alternative\u0026rdquo; (male 30\u0026ndash;34 years \u0026ndash; low/non-adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome participants expressed feeling the diagnosis of OSA and CPAP treatment was taboo.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It's nice that there were others who knew about it, but I would also like to keep it to myself - I don't think it's anyone else's business what diseases I have or don't have\u0026rdquo; (male 30\u0026ndash;34 years \u0026ndash; low/non-adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAlmost all participants with good adherence described being open about their CPAP treatment with their family and friends. In the participants with low/non-adherence, openness about CPAP treatment was more varied. About half did not want or did not feel the need to talk to their family/friends about CPAP treatment. Some saw challenges in staying overnight outside and/or with others.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I'm going to a summer house with some friends who don't know I have sleep apnoea - I'm already thinking about it\u0026rdquo; (female 35\u0026ndash;39 years \u0026ndash; adherent)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInformation and support from the sleep clinic\u003c/h2\u003e \u003cp\u003eThe participants shared their experiences from the first visits to the sleep clinic regarding the professional support and information they had received and future ways of using support to succeed with the CPAP treatment. Generally, the participants assessed that the information they received at the clinic was sufficient and informative during medical and nursing consultations. Some described that it provided reassurance, while others emphasised the nurse's and doctor's ability to be positive, answer relevant questions, make practical suggestions, and take time for the individual, such as demonstrating sleep data on a PC screen and providing visual demonstrations by the doctor of the anatomy of the throat. All of the above factors impacted the initiation of treatment.\u003c/p\u003e \u003cp\u003e Topics not addressed during the initial conversation but important to participants included the long-term aim for CPAP treatment and the consequences of untreated sleep apnoea. Some participants wished they had received more information about how difficult it could be to adjust to CPAP treatment. Others were unsure if they had received the desired information or had forgotten it, such as about comorbidities, driver's license regulations, cleaning, mask selection, adherence requirements, and tele-monitoring.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Ordering equipment and changing filters, it's definitely not information that has stuck with me if I have been told about it\u0026rdquo; (male 60\u0026ndash;64 years, low/non-adherent)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eDespite the valuable information, many found the situation overwhelming, and some described that they could not process more information. Other critical comments included feeling that the consultation with the doctor was too fast and that they were just a number in a queue.\u003c/p\u003e \u003cp\u003eMany of the participants were positive about the possibility of group consultations but not necessarily keen to participate themselves. Likewise, the participants had widely different desires for the composition of such a group. Some wanted to meet others of the same age and gender, so they were with like-minded people. Others thought the challenge would be the same whether they were 20 or 60 years old, in the workforce or not. However, everyone agreed that the group size should not exceed six people.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Groups would not make a difference to me, of course, there may be some questions from other patients that you haven't thought of yourself\u0026rdquo; (male 65\u0026ndash;69 years - adherent)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Participants with good adherence said they did not want or feel the need to participate in groups. Reasons included that it would be crossing a boundary, fear of not being heard or appearing dumb, keeping intimate questions to themselves, and exposing themselves.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;No one will ask dumb questions, no one will attract attention, no one will appear dumb, no one will ask embarrassing questions, no one will say what do I do when I want to have sex\u0026rdquo; (female 50\u0026ndash;54 years - adherent)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e In the first period after initiation of CPAP treatment, the participants were positive about telephone and email contact with the Sleep clinic, where it was easy for them to get in touch and receive quick responses. Many participants described these communication channels as a \"lifeline\" combined with the information from the distributed brochures.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Ordering [\u003c/em\u003eCPAP spare parts\u003cem\u003e] is simply top grade, I call the sleep clinic, and then I have it in my mailbox just as quick as the Postal Service could manage\u0026rdquo; (male 65\u0026ndash;69 years - adherent)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAt the follow-up check after 6\u0026ndash;8 weeks, participants were satisfied with the opportunity to refresh healthcare information, ask additional questions after treatment initiation, and have the machine and mask reviewed again. Participants described these as factors that impacted whether treatment succeeded.\u003c/p\u003e \u003cp\u003eIn general, most participants preferred physical consultations compared to virtual/phone contacts as they felt they would get more out of seeing and discussing their development in treatment sitting across from a healthcare professional rather than on a screen. Participants preferring virtual check-ins highlighted the benefits of avoiding the drive and taking time off work. However, virtual contact was only considered relevant when the treatment worked and there were no problems to discuss and only if the patients still had an opportunity to come into the sleep clinic in case of problems.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Attendance is definitely an advantage, I had some things that needed adjusting, I want to see and hear the people I need to explain it to\u0026rdquo; (male 45\u0026ndash;49 years - adherent)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Despite no specific questions during the interview, several participants focused on the need for other treatment options to CPAP. In particular, they inquired about treatment with dental appliances, weight loss, and possible surgery.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Of course, I had hoped that I could just have surgery, but that was not the case\u0026rdquo; (male 30\u0026ndash;34 years, low/non-adherent)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore newly diagnosed patients with OSA's experience of 1) receiving an OSA diagnosis, 2) motivation for CPAP treatment, and 3) essential factors to succeed with CPAP treatment, including support from a sleep clinic. The patients experienced frustration, concern, hope, and relief when receiving the OSA diagnosis. Initially, motivation for treatment was good for most, as they hoped their OSA symptoms and the risk of comorbidities would be reduced. Both the adherent and low/non-adherent groups of participants agreed that the most important facilitators for successful CPAP treatment were an open attitude, positive expectations, noticeable treatment effects, and support from family and the sleep clinic.\u003c/p\u003e \u003cp\u003eA common issue across the derived themes was motivation. Participants described knowledge of the OSA disease, expectations of treatment, and risks of comorbidities with untreated OSA as motivating factors for ensuring treatment worked. Therefore, it is important to address these issues early in the treatment process to optimise the motivational interventions for improved patient outcomes (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Participants who experienced an effect of CPAP treatment, such as less fatigue, became even more motivated to ensure CPAP treatment was successful. Conversely, participants who did not immediately experience the effect of treatment had a more challenging time finding the motivation to become \"friends\" with the CPAP device. Practical challenges such as problems with the mask, hose, and machine could also contribute to lower motivation, as seen in a previous qualitative study (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). To obtain support in case of practical challenges, patients need easy access to help from a sleep clinic, such as through phone or online contact.\u003c/p\u003e \u003cp\u003eFor participants, it was imperative to have support from their partner, and many described how the CPAP device affected their relationship, and for some, it had some negative consequences. The role of spouses/partners in initiating patients' CPAP treatment has been described in previous studies (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and investigated in a scoping review from 2022 (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), with 21 studies, of which five were qualitative (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The review concluded that the support of the relatives, especially at the beginning of the treatment, is essential for the patient's use and motivation for CPAP treatment. The involvement of relatives will provide the relatives with a better foundation to support and motivate the patient and may help reduce possible concerns and resistance to the CPAP treatment. Furthermore, treatment of OSA with CPAP can have health benefits for spouses/partners too (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Collaborative partner involvement may be a useful strategy for increasing CPAP adherence. Therefore, healthcare professionals could consider involving relatives at the start of treatment. For example, encouraging patients to include a relative at the first consultation in the sleep clinic and allowing the relatives' concerns and issues to be addressed in the consultation. If they cannot attend physically, it may be possible to give them online access if the patient agrees. Patients without relatives may need additional support from the sleep clinic staff to ensure adherence.\u003c/p\u003e \u003cp\u003eDespite participants reporting that they feel well-informed about the treatment, several indicated that they would have liked more information about the length of the adaptation period. Others suggested that an extensive amount of information should not be given simultaneously. Health literacy is the ability to read, understand, critically appraise, and use health-related information (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). A Danish study found that between 14.5% and 18.3% of adults find it challenging to follow health instructions, ensure that healthcare providers understand their problems correctly, and feel unable to discuss their health concerns with healthcare providers (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). A patient\u0026rsquo;s health literacy level is associated with self-management ability in chronic diseases (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Thus, we expect that low health literacy will also affect the ability to succeed with CPAP treatment among patients with OSA.\u003c/p\u003e \u003cp\u003eSleep clinics could consider splitting the information session in half and providing video podcasts and written information as supplements. In addition, it may be relevant to plan earlier follow-up support after initiation of treatment, i.e. after two weeks so that the patient can report start-up problems and treatment can be adjusted before the problems grow too big. This follow-up could be virtual (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) unless patients are experiencing problems with the mask and need another type. Follow-up support should target the patient's health literacy level to reduce the number of patients with low or no adherence. The difference in participants' attitudes towards attendance or virtual check-ups reflects the need for more individually tailored follow-up, too.\u003c/p\u003e \u003cp\u003eOur expectation for the study was that the group's experiences with good adherence would differ from those with poor adherence. However, there were surprisingly many similarities in their experiences and thoughts about the OSA diagnosis and starting CPAP treatment. However, there was a clear tendency for participants with good adherence to be open about their illness, whereas participants in the non-adherence group were often more closed and/or did not think others should be involved. This observation also expresses the enormous taboo that still exists in society about OSA, which some participants described as a social burden.\u003c/p\u003e \u003cp\u003eThe reason for poor adherence to CPAP in patients with OSA is multifactorial (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Thus, it is important that we, as healthcare professionals, address the whole patient, not just the practical management of the CPAP device and the biomedical aspects. As described in a previous study, a biopsychosocial understanding is needed. There should be opportunities to discuss the psychosocial factors that can constitute barriers to treatment success with the health professionals (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This includes the patient\u0026rsquo;s feelings about diagnosis, partner\u0026rsquo;s attitude and reactions, openness about the treatment, concerns related to CPAP treatment, and feelings if treatment fails. It should also involve information about where and how the patient can receive support when facing problems.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eOne of the strengths of this study is that the participants include patients who have successfully started CPAP treatment and participants who found it problematic and did not achieve high adherence. In addition, we included participants of different ages, relationship statuses, comorbidities, and body mass index, so the interviewed group reflects the population we see daily in the sleep clinic. Furthermore, it is a strength that the author group consists of doctors and nurses with extensive knowledge in the field and nurses and researchers from other specialties, so data was not only interpreted from a discipline-specific perspective. Finally, we assessed that we had achieved sufficient \"information power\" with 19 participants. There was not much new information in the last 2\u0026ndash;3 interviews, but it may be a limitation that there was only one woman in the low adherence group despite striving for similar variety in sex between groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePerspectives\u003c/h2\u003e \u003cp\u003eThis study has helped us gain knowledge about the barriers that patients struggle with in their daily lives to make the treatment successful, and the clinical opportunities to include psychosocial areas in the dialogue, tailor the information to the individual participant's needs and health literacy level, and develop follow-up support options for patients with low or non-adherence. Future studies could explore whether implementing a biopsychosocial approach, involvement of relatives and different approaches to information and follow-up can contribute to successful CPAP treatment for more patients.\u003c/p\u003e \u003cp\u003eWe found that family members significantly impacted participants' motivation, and future studies could consider examining the group of non-adherent patients and their motivation concerning whether they have a supportive partner, a partner who dislikes the CPAP device, or perhaps no family member who can support their treatment. In these cases, healthcare providers may offer special follow-up care to this specific patient group.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWhen receiving an OSA diagnosis, patients experience frustration, concern, hope, and relief. Initially, their motivation for treatment is good, as they hope that their OSA symptoms and the risk of comorbidities will be reduced. Regardless of adherence level, patients with OSA describe barriers to successful CPAP treatment as lack of support from their partner and problems with the mask, hose, or machine. The most important facilitators for successful CPAP treatment are positive expectations, personal resources, an open attitude to tell others about the treatment, noticeable treatment effects, and support from family, the broader social network, and the sleep clinic. Early follow-up support, a biopsychosocial approach, and relatives' involvement in the sleep clinic consultations are needed to support more patients toward successful CPAP treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI, body mass index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCPAP, continuous positive airway pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eESS, Epworth sleepiness scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOSA, obstructive sleep apnoea\u003c/p\u003e\n\u003cp\u003ePAP, positive airway pressure\u003c/p\u003e\n\u003cp\u003eAHI, apnoea-hypopnoea index\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe Regional Scientific Ethical Committees in The Region of Southern Denmark decided no formal approval was needed in accordance with Danish law as it was not a biomedical study (Journal nr.: S-2022000-104).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWe obtained written consent from the participants.\u0026nbsp;No names, details, or sensitive information are reported to ensure confidentiality and conceal the participants\u0026rsquo; identities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analysed during the current study are not publicly available in accordance with Danish law and due to personal information in the interviews. Data are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e We received funding from the Danish Life Science Cluster \u0026ndash; Region of Southern Denmark.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e All authors collaborated on the study\u0026rsquo;s design. ARG, IDD and MBJ interviewed the participants. The analysis and discussion of the findings were conducted by the entire author team. KJ, ARG, IDD and MBJ drafted the initial version, and JP provided critical revisions to the paper. All authors have reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We thank all the patients who participated in the interviews and the two patient research partners for their input to the interview guide. Also, thank you to Caroline Margaret Moos for linguistic revisions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMalhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002;360(9328):237-45.\u003c/li\u003e\n\u003cli\u003eSenaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81.\u003c/li\u003e\n\u003cli\u003ePeppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14.\u003c/li\u003e\n\u003cli\u003eYoung T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39.\u003c/li\u003e\n\u003cli\u003eJennum PJ, Larsen P, Cerqueira C, Schmidt T, T\u0026oslash;nnesen P. The Danish National Database for Obstructive Sleep Apnea. Clin Epidemiol. 2016;8:573-6.\u003c/li\u003e\n\u003cli\u003eJennum P, Ibsen R, Kjellberg J. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study. Thorax. 2013;68(10):949-54.\u003c/li\u003e\n\u003cli\u003eJennum P, T\u0026oslash;nnesen P, Ibsen R, Kjellberg J. Obstructive sleep apnea: effect of comorbidities and positive airway pressure on all-cause mortality. Sleep Med. 2017;36:62-6.\u003c/li\u003e\n\u003cli\u003eJennum P, Ibsen R, Kjellberg J. Morbidity prior to a diagnosis of sleep-disordered breathing: a controlled national study. J Clin Sleep Med. 2013;9(2):103-8.\u003c/li\u003e\n\u003cli\u003eSalari N, Khazaie H, Abolfathi M, Ghasemi H, Shabani S, Rasoulpoor S, et al. The effect of obstructive sleep apnea on the increased risk of cardiovascular disease: a systematic review and meta-analysis. Neurol Sci. 2021.\u003c/li\u003e\n\u003cli\u003eJordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-47.\u003c/li\u003e\n\u003cli\u003eUdholm N, Rex CE, Fuglsang M, Lundbye-Christensen S, Bille J, Udholm S. Obstructive sleep apnea and road traffic accidents: a Danish nationwide cohort study. Sleep Med. 2022;96:64-9.\u003c/li\u003e\n\u003cli\u003eBerry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619.\u003c/li\u003e\n\u003cli\u003ePatil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med. 2019;15(2):301-34.\u003c/li\u003e\n\u003cli\u003eSawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15(6):343-56.\u003c/li\u003e\n\u003cli\u003eChen YF, Hang LW, Huang CS, Liang SJ, Chung WS. Polysomnographic predictors of persistent continuous positive airway pressure adherence in patients with moderate and severe obstructive sleep apnea. Kaohsiung J Med Sci. 2015;31(2):83-9.\u003c/li\u003e\n\u003cli\u003eKribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147(4):887-95.\u003c/li\u003e\n\u003cli\u003eAl-Abri MA, Al-Harmeli A, Al-Habsi M, Jaju D. Acceptance and Compliance of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea: Local Population Survey. Oman Med J. 2020;35(6):e198.\u003c/li\u003e\n\u003cli\u003eJacobsen AR, Eriksen F, Hansen RW, Erlandsen M, Thorup L, Damg\u0026aring;rd MB, et al. Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. PLoS One. 2017;12(12):e0189614.\u003c/li\u003e\n\u003cli\u003eYi H, Shang S, Zhang Y, Zhang C, Xu L, Wang J, et al. Study on adherence to positive airway pressure treatment for patients with obstructive sleep apnea using real-world big data in a telemedicine management system. Methods. 2022;204:92-100.\u003c/li\u003e\n\u003cli\u003eLuyster FS, Dunbar-Jacob J, Aloia MS, Martire LM, Buysse DJ, Strollo PJ. Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis. Behav Sleep Med. 2016;14(1):67-84.\u003c/li\u003e\n\u003cli\u003eChou MSH, Ting NCH, El-Turk N, Harrington Z, Dobler CC. Treatment burden experienced by patients with obstructive sleep apnoea using continuous positive airway pressure therapy. PLoS One. 2021;16(6):e0252915.\u003c/li\u003e\n\u003cli\u003eAlmeida FR, Henrich N, Marra C, Lynd LD, Lowe AA, Tsuda H, et al. Patient preferences and experiences of CPAP and oral appliances for the treatment of obstructive sleep apnea: a qualitative analysis. Sleep Breath. 2013;17(2):659-66.\u003c/li\u003e\n\u003cli\u003eBrown A, Jones S, Perez-Algorta G. Experiences of using positive airway pressure for treatment of obstructive sleep apnea: a systematic review and thematic synthesis. Sleep. 2021;44(10).\u003c/li\u003e\n\u003cli\u003eM\u0026oslash;kleby M, Mengshoel AM. Devoted or negotiated routes of adherence: Narratives of patients with obstructive sleep apnoea using a continuous positive airway pressure device. Nurs Open. 2019;6(3):1237-44.\u003c/li\u003e\n\u003cli\u003eRapelli G, Pietrabissa G, Manzoni GM, Bastoni I, Scarpina F, Tovaglieri I, et al. Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front Psychol. 2021;12:705364.\u003c/li\u003e\n\u003cli\u003eGraneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12.\u003c/li\u003e\n\u003cli\u003eGreen J, Thorogood N. Qualitative methods for health research. 4th ed. Los Angeles: SAGE; 2018.\u003c/li\u003e\n\u003cli\u003eJohns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5.\u003c/li\u003e\n\u003cli\u003eKendzerska TB, Smith PM, Brignardello-Petersen R, Leung RS, Tomlinson GA. Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review. Sleep Med Rev. 2014;18(4):321-31.\u003c/li\u003e\n\u003cli\u003ePatton MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999;34(5 Pt 2):1189-208.\u003c/li\u003e\n\u003cli\u003eMalterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753-60.\u003c/li\u003e\n\u003cli\u003eAalaei S, Rezaeitalab F, Tabesh H, Amini M, Afsharisaleh L, Mostafavi SM, et al. Factors Affecting Patients\u0026apos; Adherence to Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea Disorder: A Multi-Method Approach. Iran J Med Sci. 2020;45(3):170-8.\u003c/li\u003e\n\u003cli\u003eWard K, Hoare KJ, Gott M. What is known about the experiences of using CPAP for OSA from the users\u0026apos; perspective? A systematic integrative literature review. Sleep Med Rev. 2014;18(4):357-66.\u003c/li\u003e\n\u003cli\u003eRosa D, Amigoni C, Rimoldi E, Ripa P, Ligorio A, Fracchiolla M, et al. Obstructive Sleep Apnea and Adherence to Continuous Positive Airway Pressure (CPAP) Treatment: Let\u0026apos;s Talk about Partners! Healthcare (Basel). 2022;10(5).\u003c/li\u003e\n\u003cli\u003eYe L, Antonelli MT, Willis DG, Kayser K, Malhotra A, Patel SR. Couples\u0026apos; experiences with continuous positive airway pressure treatment: a dyadic perspective. Sleep Health. 2017;3(5):362-7.\u003c/li\u003e\n\u003cli\u003eElfstr\u0026ouml;m M, Karlsson S, Nilsen P, Fridlund B, Svanborg E, Brostr\u0026ouml;m A. Decisive situations affecting partners\u0026apos; support to continuous positive airway pressure-treated patients with obstructive sleep apnea syndrome: a critical incident technique analysis of the initial treatment phase. J Cardiovasc Nurs. 2012;27(3):228-39.\u003c/li\u003e\n\u003cli\u003eGibson R, Campbell A, Mather S, Neill A. From diagnosis to long-term management: the experiences of older New Zealanders with obstructive sleep apnoea. J Prim Health Care. 2018;10(2):140-9.\u003c/li\u003e\n\u003cli\u003eWard KG, M. Hoare, K. Making choices about CPAP: Findings from a grounded theory study about living with CPAP. Collegian. 2018;25(1):81-8.\u003c/li\u003e\n\u003cli\u003eLuyster FS. Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review. J Clin Sleep Med. 2017;13(3):467-77.\u003c/li\u003e\n\u003cli\u003eMaindal HV-J, K. Health Literacy \u0026ndash; Theory, Research and Practice2016; Vol. 30:[p. 3-16. pp.].\u003c/li\u003e\n\u003cli\u003eBo A, Friis K, Osborne RH, Maindal HT. National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults. BMC Public Health. 2014;14:1095.\u003c/li\u003e\n\u003cli\u003eMackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making. 2016;36(6):741-59.\u003c/li\u003e\n\u003cli\u003eAlsaif SS, Kelly JL, Little S, Pinnock H, Morrell MJ, Polkey MI, et al. Virtual consultations for patients with obstructive sleep apnoea: a systematic review and meta-analysis. Eur Respir Rev. 2022;31(166).\u003c/li\u003e\n\u003cli\u003eBrostr\u0026ouml;m A, Nilsen P, Johansson P, Ulander M, Str\u0026ouml;mberg A, Svanborg E, et al. Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: a qualitative content analysis. Sleep Med. 2010;11(2):126-30.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CPAP, apnoea-hypopnoea index, semi-structured, adherence, sleep clinic, qualitative content analysis","lastPublishedDoi":"10.21203/rs.3.rs-4330546/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4330546/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe prevalence of obstructive sleep apnoea ranges from 6% to 17% in the general adult population. Untreated obstructive sleep apnoea is associated with cardiovascular disease, diabetes, traffic accidents, and decreased quality of life. Continuous positive airway pressure (CPAP) therapy is the gold standard for treating obstructive sleep apnoea. However, only approximately half of all treated patients succeed with this therapy. There is a lack of knowledge about the patient experience of CPAP treatment and the barriers and facilitators to successful CPAP treatment. The study aimed to explore how newly diagnosed patients with OSA experience receiving the diagnosis, their motivation for treatment, and essential factors for successful CPAP treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A qualitative design using individual semi-structured interviews was applied. Patients with successful (n=10) and unsuccessful (n=9) treatment were interviewed. Qualitative Content Analysis inspired by Graneheim and Lundman was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The analysis derived five themes: “Symptoms and thoughts about the diagnosis and CPAP treatment”, “Expectations and personal resources are important for success”, “The experience of problems and benefit from CPAP treatment”, “Social impact of CPAP treatment” and “Information and support from the sleep clinic.”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Newly diagnosed patients with obstructive sleep apnoea describe barriers to successful CPAP treatment as lack of support from their partner and problems with the equipment. Important facilitators are positive expectations, partner support, and noticeable treatment effects. Early follow-up support, a biopsychosocial approach, and relatives' involvement in the sleep clinic consultations are needed to support patients toward successful CPAP treatment.\u003c/p\u003e","manuscriptTitle":"Patients’ experiences of barriers and facilitators with continuous positive airway pressure therapy in obstructive sleep apnoea – a qualitative interview study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-08 09:52:23","doi":"10.21203/rs.3.rs-4330546/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-03T13:51:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-02T05:43:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"160030389435508157419280993737571477906","date":"2025-04-02T05:35:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-14T05:13:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250976387613277263376082475587197360060","date":"2024-05-14T23:36:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-13T07:29:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-02T15:07:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-02T15:07:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2024-04-26T15:20:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f48ea36b-5d31-4690-9897-b30d34d79557","owner":[],"postedDate":"May 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-23T15:59:50+00:00","versionOfRecord":{"articleIdentity":"rs-4330546","link":"https://doi.org/10.1186/s13690-025-01645-w","journal":{"identity":"archives-of-public-health","isVorOnly":false,"title":"Archives of Public Health"},"publishedOn":"2025-06-16 15:57:15","publishedOnDateReadable":"June 16th, 2025"},"versionCreatedAt":"2024-05-08 09:52:23","video":"","vorDoi":"10.1186/s13690-025-01645-w","vorDoiUrl":"https://doi.org/10.1186/s13690-025-01645-w","workflowStages":[]},"version":"v1","identity":"rs-4330546","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4330546","identity":"rs-4330546","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}