Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European-wide picture of the bed partner's attitude and support towards continuous positive airway pressure therapy, including effects on relationship satisfaction and intimacy. The English translation of a German bed partner questionnaire, assessing relationship satisfaction and three major components (general attitude, perceived mask looks, intimacy effects) was distributed within the European Sleep Apnea Database Network and translated in participating countries' local language. Data were collected for 2 years. In total, 10 European countries (13 sleep centres) participated with 1546 questionnaires. Overall, 91% of bed partners had a positive attitude towards continuous positive airway pressure therapy, 86% perceived mask looks not negative, 64% stated no negative intimacy effects. More specifically, 71% mentioned improved sleep quality, 68% supported nightly device usage. For 41% of bed partners, relationship satisfaction increased (no change for 47%). These results were significantly more pronounced in Eastern/Southern Europe compared with Middle Europe, especially regarding intimacy effects. However, increased continuous positive airway pressure therapy length affected attitude negatively. These results provide necessary information to improve treatment strategies by including educational couple-focused approaches. Among others, we revealed that negative intimacy effects are not considered a barrier to continuous positive airway pressure adherence. These results may inspire more research identifying regional gaps with need for treatment adjustments.

Center for Research and Innovation in Precision Medicine of Respiratory Diseases Department of Pulmonology Victor Babes University of Medicine and Pharmacy Timisoara Timișoara Romania

Department of Chest Diseases Faculty of Medicine Ege University Izmir Turkey

Department of Clinical Therapeutics Division of Pulmonary Medicine National and Kapodistrian University of Athens School of Medicine Athens Greece

Department of Medicine Southwest Medical University Affiliated Zigong Hospital Zigong China

Department of Sleep Medicine Royal Infirmary Edinburgh Edinburgh UK

Grenoble Alpes University Inserm U1300 CHU Grenoble Alpes Grenoble France

Interdisciplinary Center of Sleep Medicine Charité Universitätsmedizin Berlin Berlin Germany

Multidisciplinary Sleep Disorders Centre Antwerp University Hospital and University of Antwerp Edegem Belgium

National Institute of Mental Health Klecany Czech Republic

Respiratory Failure Unit Aristotle University of Thessaloniki G Papanikolaou Hospital Thessaloniki Greece

Respiratory Function and Sleep Unit Clinical Scientific Institutes Maugeri IRCCS Pavia Italy

Sleep and Non Invasive Ventilation Unit Hospital São João Porto Faculty of Medicine Porto University Porto Portugal

Sleep Disorders Centre University Hospital Gasthuisberg Leuven Belgium

Sleep Disorders Unit Department of Respiratory Medicine School of Medicine University of Crete Rethymno Greece

See more in PubMed

Baron, C. E., Smith, T. W., Baucom, B. R., Uchino, B. N., Williams, P. G., Sundar, K. M., & Czajkowski, L. (2020). Relationship partner social behavior and continuous positive airway pressure adherence: The role of autonomy support. Health Psychology, 39, 325–334.

Baron, K. G., Gilles, A., Sundar, K. M., Baucom, R. W., Duff, K., & Troxel, W. (2022). Rationale and study protocol for We‐PAP: A randomized pilot/feasibility trial of a couples‐based intervention to promote PAP adherence and sleep health compared to an educational control. Pilot and Feasibility Studies, 1(8), 171. https://doi.org/10.1186/s40814-022-01089-x

Baron, K. G., Smith, T. W., Berg, C. A., Czajkowski, L. A., Gunn, H., & Jones, C. R. (2011). Spousal involvement in CPAP adherence among patients with obstructive sleep apnea. Sleep & Breathing, 15, 525–534.

Baron, K. G., Smith, T. W., Czajkowski, L. A., Gunn, H. E., & Jones, C. R. (2009). Relationship quality and CPAP adherence in patients with obstructive sleep apnea. Behavioral Sleep Medicine, 7(1), 22–36.

Benjafield, A. V., Ayas, N. T., Eastwood, P. R., Heinzer, R., Ip, M. S. M., Morrell, M. J., Nunez, C. M., Patel, S. R., Penzel, T., Pépin, J. L., Peppard, P. E., Sinha, S., Tufik, S., Valentine, K., & Malhotra, A. (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature‐based analysis. The Lancet Respiratory Medicine, 7(8), 687–698. https://doi.org/10.1016/S2213-2600(19)30198-5

Billings, M. E., Auckley, D., Benca, R., Foldvary‐Schaefer, N., Iber, C., Redline, S., Rosen, C. L., Zee, P., & Kapur, V. K. (2011). Race and residential socioeconomics as predictors of CPAP adherence. Sleep, 34(12), 1653–1658.

Bonsignore, M. R., Hedner, J., & ESADA Study Group. (2018). The European Sleep Apnoea Database (ESADA) ERS clinical research collaboration: Past, present and future. European Respiratory Journal, 52(4), 1801666. https://doi.org/10.1183/13993003.01666-2018

Broström, A., Nilsen, P., Johansson, P., Ulander, M., Strömberg, A., Svanborg, E., & Fridlund, B. (2010). Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis. Sleep Medicine, 11, 126–130. https://doi.org/10.1016/j.sleep.2009.04.010

Budhiraja, R., Parthasarathy, S., Drake, C. L., Roth, T., Sharief, I., Budhiaja, P., Saunders, V., & Hudgel, D. W. (2007). Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep, 30(3), 320–324.

Cartwright, R. D. (2008). Sleeping together: A pilot study of the effects of shared sleeping on adherence to CPAP treatment in obstructive sleep apnea. Journal of Clinical Sleep Medicine, 4(2), 123–127.

Chen, X., Wang, R., Zee, P., Lutsey, P. L., Javaheri, S., Alcántara, C., Jackson, C. L., Williams, M. A., & Redline, S. (2015). Racial/ethnic differences in sleep disturbances: The Multi‐Ethnic Study of Atherosclerosis (MESA). Sleep, 38(6), 877–888.

Cistulli, P. A., Armitstead, J., Pepin, J. L., Woehrle, H., Nunez, C. M., Benjafield, A., & Malhotra, A. (2019). Short‐term CPAP adherence in obstructive sleep apnea: A big data analysis using real world data. Sleep Medicine, 59, 114–116. https://doi.org/10.1016/j.sleep.2019.01.004

Cunningham, M. R. (1979). Weather, mood, and helping behavior: Quasi experiments with the sunshine samaritan. Journal of Personality and Social Psychology, 37, 1947–1956.

Doherty, L. S., Kiely, J. L., Lawless, G., & McNicholas, W. T. (2003). Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome. Chest, 124(6), 2209–2214.

Dunietz, G. L., Yu, Y., Levine, R. S., Conceicao, A. S., Burke, J. F., Chervin, R. D., & Braley, T. J. (2021). Obstructive sleep apnea in older adults: Geographic disparities in PAP treatment and adherence. Journal of Clinical Sleep Medicine, 17(3), 421–427. https://doi.org/10.5664/jcsm.8914

Engleman, H. M., Asgari‐Jirhandeh, N., McLeod, A. L., Ramsay, C. F., Deary, I. J., & Douglas, N. J. (1996). Self‐reported use of CPAP and benefits of CPAP therapy: A patient survey. Chest, 109(6), 1470–1476.

Fietze, I., Laharnar, N., Bargiotas, P., Basoglu, O. K., Dogas, Z., Drummond, M., Fanfulla, F., Gislason, T., Gouveris, H., Grote, L., Hein, H., Jennum, P., Joppa, P., van Kralingen, K., Kvamme, J. A., Lombardi, C., Ludka, O., Mallin, W., Marrone, O., … Penzel, T. (2022). Management of obstructive sleep apnea in Europe ‐ a 10‐year follow‐up. Sleep Medicine, 97, 64–72. https://doi.org/10.1016/j.sleep.2022.06.001

Fietze, I., Laharnar, N., Obst, A., Ewert, R., Felix, S. B., Garcia, C., Gläser, S., Glos, M., Schmidt, C. O., Stubbe, B., Völzke, H., Zimmermann, S., & Penzel, T. (2019). Prevalence and association analysis of obstructive sleep apnea with gender and age differences ‐ results of SHIP‐trend. Journal of Sleep Research, 28(5), e12770. https://doi.org/10.1111/jsr.12770

Fietze, I., Penzel, T., Alonderis, A., Barbe, F., Bonsignore, M. R., Calverly, P., de Backer, W., Diefenbach, K., Donic, V., & Eijsvogel, M. M. (2011). Management of obstructive sleep apnea in Europe. Sleep Medicine, 12(2), 190–197. https://doi.org/10.1016/j.sleep.2010.10.003

Fietze, I., Rosenblum, L., Ossadnik, S., et al. (2023). Nocturnal positive pressure ventilation improves relationship quality of OSA patients and their partners. Sleep Medicine, 111, 191–198. https://doi.org/10.1016/j.sleep.2023.08.023

Gentina, T., Bailly, S., Jounieqeaux, F., Verkindre, C., Broussier, P.‐M., Guffroy, D., Prigent, A., Gres, J.‐J., Kabbani, J., Kedziora, L., Tamisier, R., Gentina, E., & Pépin, J.‐L. (2019). Marital quality, partner's engagement and continuous positive airway pressure adherence in obstructive sleep apnea. Sleep Medicine, 55, 56–61. https://doi.org/10.1016/j.sleep.2018.12.009

Grote, L., McNicholas, W. T., & Hedner, J. (2020). ESADA collaborators. Sleep apnoea management in Europe during the COVID‐19 pandemic: Data from the European Sleep Apnoea Database (ESADA). The European Respiratory Journal, 55(6), 2001323. https://doi.org/10.1183/13993003.01323-2020

Gurka, M. J., Filipp, S. L., & DeBoer, M. D. (2018). Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults. Nutrition & Diabetes, 8(1), 14.

Hoy, C. J., Vennelle, M., Kingshott, R. N., Engleman, H. M., & Douglas, N. J. (1999). Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? American Journal of Respiratory and Critical Care Medicine, 159, 1096–1100.

Kiely, J. L., & McNicholas, W. T. (1997). Bed Partners' assessment of nasal continuous positive airway pressure therapy in obstructive sleep apnea. Chest, 111(5), 1261–1265.

Lai, A. Y., Ip, M. S., Lam, J. C., Weaver, T. E., & Fong, D. Y. (2016). A pathway underlying the impact of CPAP adherence on intimate relationship with bed partner in men with obstructive sleep apnea. Sleep & Breathing, 20(2), 543–551. https://doi.org/10.1007/s11325-015-1235-6

Lanska, D. J., & Kuller, L. H. J. S. (1995). The geography of stroke mortality in the United States and the concept of a stroke belt. Stroke, 26(7), 1145–1149.

Luyster, F. S. (2017). Impact of obstructive sleep apnea and its treatments on partners: A literature review. Journal of Clinical Sleep Medicine, 13(3), 467–477.

Luyster, F. S., Aloia, M. S., Buysse, D. J., Dunbar‐Jacob, J., Martire, L. M., Sereika, S. M., & Strollo, P. J. (2019). A couples‐oriented intervention for positive airway pressure therapy adherence: A pilot study of obstructive sleep apnea patients and their partners. Behavioral Sleep Medicine, 17(5), 561–572. https://doi.org/10.1080/15402002.2018.1425871

Luyster, F. S., Dunbar‐Jacob, J., Aloia, M. S., Martire, L. M., Buysse, D. J., & Strollo, P. J. (2016). Patient and partner experiences with obstructive sleep apnea and CPAP treatment: A qualitative analysis. Behavioral Sleep Medicine, 14(1), 67–84. https://doi.org/10.1080/15402002.2014.946597

Martire, L. M., Schulz, R., Helgeson, V. S., Small, B. J., & Saghafi, E. M. (2010). Review and meta‐analysis of couple‐oriented interventions for chronic illness. Annals of Behavioral Medicine, 40(3), 325–342.

McArdle, N., Kingshott, R., Engleman, H. M., Mackay, T. W., & Douglas, N. J. (2001). Partners of patients with sleep apnoea/hypopnoea syndrome: Effect of CPAP treatment on sleep quality and quality of life. Thorax, 56(7), 513–518. doi:10.1136/thx.56.7.513

Mehrtash, M., Bakker, J. P., & Ayas, N. (2019). Predictors of continuous positive airway pressure adherence in patients with obstructive sleep apnea. Lung, 197(2), 115–121. https://doi.org/10.1007/s00408-018-00193-1

Mendelson, M., Gentina, T., Gentina, E., Tamisier, R., Pépin, J. L., & Bailly, S. (2020). Multidimensional evaluation of continuous positive airway pressure (CPAP) treatment for sleep apnea in different clusters of couples. Journal of Clinical Medicine, 9(1658), 1–9. https://doi.org/10.3390/jcm9061658

National Sleep Foundation. (2005). 2005 Sleep in America Poll (pp. 21–30). National Sleep Foundation.

Newman, A. B., Nieto, F. J., Guidry, U., et al. (2001). Relation of sleep‐disordered breathing to cardiovascular disease risk factors. American Journal of Epidemiology, 154(1), 50–59.

O'Connor, G. T., Lind, B. K., Lee, E. T., Nieto, F. J., Redline, S., Samet, J. M., Boland, L. L., Walsleben, J. A., Foster, G. L., & Sleep Heart Health Study Investigators. (2003). Variation in symptoms of sleep‐disordered breathing with race and ethnicity: The sleep heart health study. Sleep, 26(1), 74–79.

Parish, J. M., & Lyng, P. J. (2003). Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure. Chest Journal, 124, 942–947.

Pépin, J. L., Bailly, S., Rinder, P., Adler, D., Szeftel, D., Malhotra, A., Cistulli, P. A., Benjafield, A., Lavergne, F., Josseran, A., Tamisier, R., Hornus, P., & The medXcloud Group. (2021). CPAP therapy termination rates by OSA phenotype: A French Nationwide database analysis. Journal of Clinical Medicine, 10(5), 936. https://doi.org/10.3390/jcm10050936

Rentfrow, P. J., Gosling, S. D., & Potter, J. (2008). A theory of the emergence, persistence, and expression of geographic variation in psychological characteristics. Perspectives on Psychological Science, 3, 339–369.

Rotenberg, B. W., Murariu, D., & Pang, K. P. (2016). Trends in CPAP adherence over twenty years of data collection: A flattened curve. Journal of Otolaryngology ‐ Head & Neck Surgery, 45(1), 43. https://doi.org/10.1186/s40463-016-0156-0

Schmitt, D. P., Allik, J., McCrae, R. R., & Benet‐Martínez, V. (2007). The geographic distribution of Big Five personality traits patterns and profiles of human self‐description across 56 nations. Journal of Cross‐Cultural Psychology, 38, 173–212.

Senaratna, C. V., Perret, J. L., Lodge, C. J., Lowe, A. J., Campbell, B. E., Matheson, M. C., Hamilton, G. S., & Dharmage, S. C. (2016). Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews, 34, 70–81. https://doi.org/10.1016/j.smrv.2016.07.002

Siccoli, M. M., Pepperell, J. C., Kohler, M., Craig, S. E., Davies, R. J., & Stradling, J. R. (2008). Effects of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: Data from a randomized controlled trial. Sleep, 31(11), 1551–1558. https://doi.org/10.1093/sleep/31.11.1551

Simon‐Tuval, T., Reuveni, H., Greenberg‐Dotan, S., Oksenberg, A., Tal, A., & Tarasiuk, A. (2009). Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep, 32(4), 545–552.

Smith, I., Nadig, V., & Lasserson, T. J. (2009). Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. The Cochrane Database of Systemic Reviews, 2, CD007736.

Staats, R., Bailly, S., Bonsignore, M. R., Ryan, S., Riha, R. L., Schiza, S., Verbraecken, J., Basoglu, O. K., Saaresranta, T., Pataka, A., Ludka, O., Lombardi, C., Hedner, J. A., Grote, L., & European Sleep Apnoea Database (ESADA) Collaborators. (2021). Impact of temperature on obstructive sleep apnoea in three different climate zones of Europe: Data from the European Sleep Apnoea Database (ESADA). Journal of Sleep Research, 30(5), e13315. https://doi.org/10.1111/jsr.13315

Wei, W., Lu, J. G., Galinsky, A. D., Wu, H., Gosling, S. D., Rentfrow, P. J., Yuan, W., Zhang, Q., Guo, Y., Zhang, M., Gui, W., Guo, X. Y., Potter, J., Wang, J., Li, B., Li, X., Han, Y. M., Lv, M., Guo, X. Q., … Wang, L. (2017). Regional ambient temperature is associated with human personality. Nature Human Behaviour, 1(12), 890–895. https://doi.org/10.1038/s41562-017-0240-0

Ye, L., Antonelli, M. T., Willis, D. G., Kayser, K., Malhotra, A., & Patel, S. R. (2017). Couples' experiences with continuous positive airway pressure treatment: A dyadic perspective. Sleep Health, 3(5), 362–367. https://doi.org/10.1016/j.sleh.2017.07.003

Ye, L., Malhotra, A., Kayser, K., Willis, D. G., Horowitz, J. A., Aloia, M. S., & Weaver, T. E. (2015). Spousal involvement and CPAP adherence: A dyadic perspective. Sleep Medicine Reviews, 19, 67–74.