Role of Partnership in PAP Therapy Adoption in Obstructive Sleep Apnea

<bold>Introduction:</bold> Positive airway pressure (PAP) therapy is an effective treatment for obstructive sleep apnea (OSA), yet treatment adherence can be further improved. Social support is an important driver of PAP treatment acceptance and use, but more work is needed to understand how it can moderate behavioral characteristics of PAP users. <bold>Methods:</bold> Users of a smartphone app to track PAP therapy usage (myAir, ResMed) completed a survey asking about their experience with PAP therapy adoption and usage, including usage facilitators and barriers, confidence and motivation, and healthcare provider and partner involvement. Guided by the Social Cognitive Theory, we examined differences in the likelihood of reaching 90-day compliance (>4 hrs/night on 70% of nights for 30 consecutive days) by partner status (partner vs. single) using Elastic net (β) and Firth (OR, 95%CI) logistic regressions adjusting for age, gender, PAP treatment duration, and self-reported BMI and AHI. <bold>Results:</bold> 6,797 users were included in the 90-day analysis (mean age (SD): 55.3 (12.8) years, 20.6% single, 58% male). The odds of confidence being associated with PAP compliance was significant among married, but not single users (OR 2.7 (1.6, 4.6), p = 0.0003 vs. 2.0 (0.8, 4.8), p = 0.1366). Being self-motivated was associated with PAP use at 90 days, but only among married users (OR 1.7 (1.2, 2.12, p = 0.0012 vs. 1.4 (0.8, 2.4), p = 0.3056). Having a partner track PAP usage was negatively associated with compliance in married users (OR 0.48 (0.36, 0.64), p < 0.0001). <bold>Conclusion:</bold> Identifying differences in confidence and motivation by partner status may help inform PAP promotion interventions and allow improvement in adherence in OSA.