Predictors of Retention in Positive Airway Pressure Therapy: Motivation, Psychological Status, and Sleep Symptom Severity.

OBJECTIVE.: To evaluate whether initial visit motivation was associated with retention throughout the obstructive sleep apnea (OSA) diagnostic and treatment pathway, including polysomnography (PSG) completion and continued follow-up after positive airway pressure (PAP) initiation, among OSA patients in South Korea. STUDY DESIGN.: Retrospective observational study. SETTING.: Tertiary hospital. METHODS.: Adult patients presenting with suspected OSA between July 2021 and December 2023 were retrospectively reviewed. Demographic characteristics, PSG results, and questionnaire scores, including the Berlin Questionnaire, Beck Depression Inventory-II (BDI-II), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index 7 (ISI), were collected. Initial visit motivation was categorized as voluntary, encouraged, both, or other based on a self-reported questionnaire completed at the first visit. Retention was analyzed using Kaplan-Meier methods and Cox proportional hazards regression. RESULTS.: A total of 139 patients were included. Patients reporting both voluntary and encouraged motivations showed higher retention than those reporting either motivation alone (log-rank p = 0.029). Multivariable analysis identified obesity, high Berlin Questionnaire risk, combined motivation, and lower depressive symptom severity as independent predictors of retention. In a sensitivity analysis restricted to patients who completed PSG, the association between motivation and retention was attenuated but remained directionally consistent. CONCLUSION.: 8 Initial motivation for seeking care was associated with clinic-based retention throughout the OSA care pathway. Assessment of patients' motivational profile at the initial visit may help identify those at risk of disengagement and facilitate individualized strategies to improve long-term retention.