Psychological predictors of CPAP therapy adherence in obstructive sleep apnea patients: insights from the predisposing, precipitating, and perpetuating factors model

Continuous positive airway pressure is the standard treatment for obstructive sleep apnoea (OSA), a condition marked by recurrent interruptions in breathing during sleep that impairs quality of life. Despite its efficacy, adherence to continuous positive air pressure (CPAP) remains suboptimal and is influenced by various psychological and contextual factors. This scoping review adopts the 3P model-predisposing, precipitating, and perpetuating factors-to identify key motivators and barriers impacting CPAP adherence in OSA patients. A systematic search of PubMed, PsycINFO, and Scopus identified 43 relevant studies. Inclusion criteria focused on peer-reviewed, full-text articles investigating psychological aspects influencing CPAP adherence in adults with OSA. Paediatric populations, non-English publications, and studies without an explicit focus on psychological variables were excluded. Predisposing factors include psychological comorbidities, low health literacy, and misconceptions about OSA and CPAP. Perpetuating factors include ongoing psychological barriers, inadequate patient education, and suboptimal communication with healthcare providers. Precipitating factors include device-related anxiety, and perceived stigma. In addition, motivators that support adherence have been identified, such as perceived improvements in quality of life, bed partners' support, and tailored educational programmes highlighting the benefits of CPAP. Interventions such as cognitive behavioural therapy and psychological patient support show promise in improving adherence. Introducing a novel application of the 3P model, this scoping review underscores the complexity of psychological and behavioral determinants of CPAP adherence, highlighting the need of a multifaceted, patient-centered approach. Future research should evaluate the effectiveness of personalized interventions through longitudinal studies to assess their impact on treatment adherence and clinical outcomes.