ABSTRACT
Since its initial description (1,2), nasal continuous positive airway pressure (CPAP) has proven to be an effective treatment for the reduction of obstructive sleep apnea (OSA)–related respiratory disturbances (1-10). Gains achieved with CPAP treatment include amelioration of sleep architecture and arousals (3,7,9,11), improved alertness (11-21), neurobehavioral performance (11-13,15,20,22), and daily functioning (11-13,15-18,23-34). Although it was previously believed that patients could occasionally take treatment holidays (10,35-37), contrary evidence indicated the importance of nightly adherence to treatment (20). Indeed, missing just one night of CPAP treatment induced the return of daytime sleepiness and disturbed sleep (20). Chronic treatment abstinence has been associated with heightened risks of cardiovascular morbidity (38-49), automobile accidents (4,12,50-62), and problems in many other areas of life (27,32,63-68), thus, the demonstrated need to apply CPAP nightly has made CPAP nonadherence one of the foremost clinical issues in the management of OSA.
