Ambivalent adherence and nonadherence to continuous positive airway pressure devices: A qualitative study

Dana Zarhin, Arie Oksenberg

Research output: Contribution to journalArticlepeer-review


Study Objectives: Continuous positive airway pressure (CPAP) therapy is considered the front-line treatment for moderate-severe obstructive sleep apnea (OSA). However, nonuse rates are very high, such that adherence to CPAP has become a major concern. Although the literature on CPAP use is vast, further research is required to understand patients' experiences of CPAP use and nonuse. This is the goal of this study. Methods: This study draws on in-depth interviews with 61 Jewish-Israeli patients with OSA who received a recommendation to use a CPAP device. The sample includes both patients who started using CPAP devices as well as patients who rejected this course of treatment. It follows principles of constructivistgrounded theory in both sampling and analysis. Results: The study shows that regardless of patients' status of adherence, their attitudes toward CPAP devices are characterized by ambivalence. Users of CPAP expressed ambivalent adherence, pondering whether they should stop using the device; and patients who rejected the CPAP expressed ambivalent nonadherence, wondering whether they should give the CPAP another chance. This study identifies the experiences involved in using, as well as not using, CPAP devices that produce patients' ambivalence. Conclusions: Both adherence and nonadherence to CPAP are dynamic processes that are characterized by patients' ambivalence and contingent upon diverse factors. These findings have practical implications as they suggest that all patients, regardless of their initial adherence status, would benefit from a close follow-up.

Original languageEnglish
Pages (from-to)1375-1384
Number of pages10
JournalJournal of Clinical Sleep Medicine
Issue number12
StatePublished - 2017


  • Adherence
  • Ambivalence
  • Compliance
  • Continuous positive airway pressure devices/CPAP therapy
  • Obstructive sleep apnea
  • Qualitative research methods

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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