Déterminants psychologiques et adhérence au traitement par pression positive continue : des outils pratiques pour une médecine du sommeil intégrative

Continuous Positive Pressure (CPAP) therapy is the gold standard treatment for Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS). CPAP used the majority of sleep time is very effective to reduce the consequences of OSAHS. However, this treatment is associated with poor long-term therapeutic observance. Increasing observance to CPAP is a public health issue in sleep medicine. Thus, it is very important to evaluate the factors that can predict a poor observance when a treatment is considered for a patient suffering from an OSAHS. First, this article recalls the clinical concepts associated with the notion of observance: in particular, the concepts of compliance and adherence. Compliance is the ability of a patient to comply with his doctor's prescription. This concept should lead the sleep doctor to evaluate the biomedical factors (ENT, dermatologic, digestive, somnologic and psychiatric) that can be associated with poor tolerance to CPAP. Adherence is the ability of a patient to appropriate in his/her personal life the doctor's prescription. This concept should lead the sleep doctor to evaluated psychological factors regarding: the perception of SAHOS and CPAP by the patient, and his/her perceived self-efficacy. Specific and validated psychometric tools can quantify these variables. Moreover, evaluated in pre-therapeutics, these variables have proved their predictive roles in CPAP observance. Thus, in addition to the accurate assessment of biomedical factors, establishing phenotypic profiles taking into account psychological variables is the pathway to optimize the efficacy, compliance and adherence to CPAP. This approach also foreshadows an integrative sleep medicine that should increase the therapeutic success in the field of chronic diseases.