Beyond the Mask―Psychological Discomfort as a Predictor of Early CPAP Nonadherence in Moderate-to-Severe OSA Patients: A Prospective Mixed-Methods Study

Background and ObjectiveEarly adherence to CPAP therapy is a critical determinant of long-term treatment adherence, but it is frequently compromised by patient-reported adverse effects. This study aimed to systematically identify CPAP-related adverse symptoms and evaluate their associations with early treatment adherence among patients with moderate-to-severe OSA.MethodsA prospective mixed-methods study was conducted at a tertiary sleep center between August 2021 and February 2025. A total of 121 adults with newly diagnosed moderate-to-severe OSA were enrolled. CPAP-related symptoms (n = 430) were collected through semistructured telephone interviews conducted at least three times. Symptoms were categorized into four domains: physiological, psychological, CPAP interface–related, and CPAP device–related. Early CPAP adherence over a 14-day trial period was defined as CPAP use for ≥ 4 h per night on ≥ 70% of nights.ResultsAmong 121 participants (mean age 50.8 years; 84.3% male), 60.3% demonstrated good adherence. Psychological symptoms were the only domain significantly associated with reduced adherence (β = −7.50%; p=0.049), with suffocation sensations showing a particularly strong negative impact (β = −37.14%; p=0.018). Conversely, CPAP interface–related symptoms such as mask discomfort were positively associated with adherence (β = 12.89%; p=0.011). Physiological and equipment-related symptoms were not significantly associated with CPAP adherence.ConclusionPsychological discomfort significantly impairs early CPAP adherence among patients with OSA. Routine assessment and timely intervention targeting psychological and interface-related complaints during the initial treatment period may help support continued CPAP use in clinical practice.Trail Registration: ClinicalTrials.gov_identifier: NCT06520592