Obstructive sleep apnea syndrome: The role of perceptions of illness and treatment in compliance issues

Michi Hatashita Wong, Fordham University


This research addresses treatment adherence in patients with obstructive sleep apnea syndrome, OSAS, by examining how patients' beliefs about the consequences of OSAS and the efficacy of their prescribed treatment affect their decisions concerning adherence to treatment. While research has shown that CPAP, the treatment of choice, is effective in alleviating OSAS symptoms, patients' compliance with CPAP treatment has been found to vary widely. Promoting sufficient treatment compliance is critical of the progressive deteriorating course and adverse medical complications associated with OSAS. OSAS patients (N = 107) participated in a telephone survey using measures of illness representations and beliefs about medical treatment to assess symptom awareness, illness threat, perceptions of adverse consequences, belief in cure or control over illness, and beliefs in the efficacy or necessity for treatment. Based on physiologically determined rates of therapeutic use, participants were divided into compliant and noncompliant CPAP use groups. Data analysis showed that greater symptom recognition and perceived belief in control over illness were significantly related to better CPAP compliance. Overall, participants did not endorse somatic symptoms as a large part of their illness experience and this was consistent with the general OSAS illness profile of low or absent symptom awareness. Belief in the necessity of CPAP in treating OSAS was also found to play an important role in the compliance process, however, no significant group differences were found when responses to perception of the adverse illness consequences, and beliefs in the general harm and overuse of medical treatments were compared. These results suggests that less compliant individuals may have a poor understanding how CPAP is effective in managing and reversing many physiological OSAS consequences. Unfortunately, the combined results of poor symptom awareness, weak acknowledgment of adverse consequences, and low perceived threat strongly support clinical observations that the somatic experience of OSAS alone does not provide enough feedback or information to instigate change in health behavior. This study provided insight into the patterns of illness representation in OSAS, and consequently, several alternative approaches to improving CPAP compliance were proposed. Training to improve symptom recognition, placing emphasis on the patient's understanding of CPAP efficacy, and developing interventions to improve perceptions of control over illness may prove to be instrumental in improving compliance rates.

Subject Area

Psychotherapy|Surgery|Physiological psychology

Recommended Citation

Wong, Michi Hatashita, "Obstructive sleep apnea syndrome: The role of perceptions of illness and treatment in compliance issues" (2000). ETD Collection for Fordham University. AAI9981412.