Adherence to positive airway pressure therapy in patients with comorbid restless legs syndrome and obstructive sleep apnea: a retrospective cohort study.

INTRODUCTION: Obstructive sleep apnea (OSA) commonly coexists with Restless Legs Syndrome (RLS). Positive Airway Pressure (PAP) treatment for coexisting OSA may alleviate RLS symptoms. However, RLS often contributes to insomnia, leading to difficulties with sleep initiation and maintenance that may compromise PAP adherence. Objective long-term adherence data in patients with comorbid RLS and OSA remains limited. This study evaluated PAP therapy adherence and its determinants in patients with comorbid RLS and OSA. METHODS: This retrospective cohort study included patients with RLS who reported snoring and underwent overnight polysomnography (PSG) from Jan 2022 to July 2024, at the Division of Sleep Medicine in the Peking University People's Hospital. Clinical features and objective PAP adherence were collected. And factors influencing adherence were assessed through semi-structured interviews. Patients were followed up 1 year after PAP initiation. Good adherence was defined as device use for ≥ 4 h/night on ≥ 70% of nights. RESULTS: Among 114 patients with RLS, 84 (73.7%) had comorbid OSA. Of these, 70 initiated PAP therapy, 37 acquired devices and only 25 provided objective adherence data. The proportion of adherent users declined progressively: 76% at 1 week, 36% at 1 month, 20% at 3 months, 16% at 6 months and 12% at 1 year. Main influencing factors included a perceived lack of need or unwillingness to continue PAP treatment, device intolerance and socioeconomic burden. CONCLUSIONS: Long-term PAP adherence appears suboptimal in this cohort of patients with comorbid RLS and OSA. Interventions targeting sleep symptom relief, device tolerability and socioeconomic factors may improve treatment adherence.