Reena Mehra, MD, MS: Adherence to CPAP in OSA


The director of the Sleep Disorders Research Program at Cleveland Clinic Lerner College of Medicine offered her perspective on the adherence challenges in treating obstructive sleep apnea with continuous positive airway pressure.

“General adherence is thought to be 50% to 70%. Our estimates here at Cleveland Clinic are a bit higher, at 80%, maybe even 90%. The struggle is, really, to try to identify the root cause of the problem, in terms of why the patient is not able to tolerate the device.”

In the treatment of obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) is considered the gold standard—and for good reason. It is highly effective in the treatment of OSA. Although, despite this efficacy, patient adherence to the treatment is generally considered a challenge, with some estimates suggesting that even with mask and machine alterations and accompanying behavioral intervention, adherence remains a severe issue in the management of OSA.1

Reena Mehra, MD, MS, director, Sleep Disorders Research Program, and professor of medicine, Cleveland Clinic Lerner College of Medicine, told NeurologyLive in an interview that the real challenge is getting to the cause of a patients’ lack of tolerability to CPAP. She noted that there are a number of potential reasons, ranging from pressure intolerance and mask issues to nasal congestion and beyond.

At Cleveland Clinic, Mehra and colleagues offer patients unique resources through its group-based CPAP clinic, where patients are offered 1-on-1 meetings with clinicians to help identify and address these issues. Mehra discussed the ways in which adherence issues can be tackled, as well as insight into why it is such a challenge for patients with OSA using CPAP and other medications.


1. Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016;45:43.doi: 10.1186/s40463-016-0156-0.

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