Sense of Coherence and Its Association With Adherence to Continuous Positive Airway Pressure (CPAP) Therapy in Patients With Obstructive Sleep Apnoea
TL;DR
It is suggested that low SOC is a risk factor for non-adherence to treatment and is a key clinical predictor for developing motivational strategies to improve treatment persistence in patients with OSA.
Abstract
Introduction: Obstructive sleep apnoea (OSA) has a negative impact on cardiovascular and cognitive health. Although continuous positive airway pressure (CPAP) is the treatment of choice, non-adherence limits its effectiveness. Sense of coherence (SOC) is a salutogenic construct that facilitates the management of chronic conditions, although its specific relationship with the use of CPAP has been little studied. Main objective: To determine the association between SOC and adherence to CPAP treatment in patients with OSA. Materials and methods: A cross-sectional analytical study was conducted between February 2025 and July 2025 at a family medicine unit of the Mexican Social Security Institute (IMSS). The study included 200 subjects diagnosed with OSA. SOC was assessed using the SOC-29 questionnaire, and treatment adherence was assessed by reading the SD cards of the devices, defined as use for more than four hours per night on at least five days per week (70% of nights over 30 days). Multiple binary logistic regression was performed for treatment adherence, with Bootstrap resampling (2,000 samples), and the odds ratio (OR) and 95% confidence interval (CI) were calculated. Results: One was found mean age was 62 (SD = 12) years, 60% (n = 120) were male, 36% (n = 72) had a primary education level, and 60% (n = 120) were married. A high SOC was identified in 74% (n = 148) of the sample, which was significantly associated with CPAP adherence (p < 0.001, Cramér's V = 0.473). In terms of weekly CPAP usage of fewer than five days, an OR of 8.538 (95% CI: 4.663-15.633) for low SOC was reported. In the multivariate model for non-adherence, low SOC remained the strongest independent risk factor for non-adherence (OR = 9.043, 95% CI: 4.359-18.761, p = 0.005). Conclusion: The findings suggest that low SOC is a risk factor for non-adherence to treatment. It is a key clinical predictor for developing motivational strategies to improve treatment persistence in patients with OSA.