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Morning Chronotype Is Associated with Improved Adherence to Continuous Positive Airway Pressure among Individuals with Obstructive Sleep Apnea. Annals of the American Thoracic Society Knauert, M. P., Adekolu, O., Xu, Z., Deng, A., Chu, J., Baldassarri, S., Kushida, C., Yaggi, H. K., Zinchuk, A. 2023

Abstract

RATIONALE: Poor adherence limits the effectiveness of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). A better understanding of CPAP adherence is needed to develop novel strategies to improve it.OBJECTIVE(S): To determine if chronotype (morning, evening or intermediate) of patients with OSA is associated with differences in CPAP adherence. If such an association exists, to determine the mechanisms underlying this association.METHODS: We performed a secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES) clinical trial. We assessed chronotype using the Morningness-Eveningness Questionnaire (MEQ) among participants randomized to the CPAP arm with daily adherence data (n=469). Evening (MEQ = 41), intermediate (41 < MEQ < 59) and morning type (MEQ = 59) categories were the exposures. We modeled daily CPAP use (hours per night) over a 6-month period, using a linear mixed model, adjusted for covariates (e.g., age, sex, marital status). To assess mechanisms of the association, we performed mediation analyses using sleep duration, weekend catch-up sleep, depression, and other factors.RESULTS: Most participants were obese men with severe OSA (body mass index of 32.3 ± 7.3 kg/m2, 65% male and AHI 39.8 ± 24.6 per hour respectively). Participants were 44% morning, 47% intermediate and 8% evening chronotype. Participants with morning chronotype reported the shortest sleep duration on weekends (7.3 vs. 7.6 and 7.9 hours per night) compared to the intermediate and evening types. Participants with morning chronotype exhibited a 40-minutes per night higher CPAP use (p=0.001) compared to persons with intermediate chronotype. This relationship was mildly attenuated (32.8 minutes per night, p = 0.011) after adjustment for covariates. None of the selected factors (e.g., sleep duration, weekend catch-up sleep) exhibited a significant mediation effect.CONCLUSIONS: Morning chronotype is associated with a clinically meaningful, increase in CPAP adherence compared with other chronotypes. Mechanisms of this association require further study. Chronotype maybe a novel predictor of CPAP adherence.CLINICAL TRIAL REGISTRATION: This analysis was a secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES) trial (clinicaltrials.gov registration: NCT00051363).

View details for DOI 10.1513/AnnalsATS.202210-885OC

View details for PubMedID 36917194