Sample characteristics

A total of 148 questionnaires with sufficient data were available for analysis. The study cohort consisted of predominantly male participants (72.8%), with a mean age of 57.9 ± 11.8 years. OSA disease history was defined as the time since patient-reported diagnosis. PAP adherence was classified based on self-reported current use versus discontinuation and verified by therapy device reports when available. Disease chronicity was notable, with most participants (59.4%) having been diagnosed with OSA for more than 36 months (Table 1). The remaining participants were distributed across shorter disease durations, with 21.8% diagnosed between 24 and 36 months prior, and 18.8% diagnosed within the previous 24 months.

Table 1 Sample characteristics (N = 148)

At the time of study participation, 58.8% (n = 87) of participants were adherent to their prescribed PAP therapy, while 41.2% (n = 61) had discontinued treatment. Participants adherent to PAP therapy were significantly older than those that discontinued treatment (60.6 ± 10.5 vs. 53.6 ± 12.3 years, p <. 001). There was no significant difference in the gender distribution across both cohorts.

Use of multiple devices was defined as documented transitions between different PAP models or masks during the course of treatment. Most participants (61.8%) had experience with a single PAP device, while 38.2% had used multiple devices throughout their treatment course. Regarding mask interfaces, 29.6% had used a single mask type, while the majority (70.4%) had experience with multiple masks during their therapy. The number of alternative treatments reflects the average number of non-PAP therapies previously attempted per patient. Most participants (70.9%) reported no experience with therapeutic options beyond PAP therapy. Among those who had sought alternative treatments, nasal surgery was the most common (14.0%), followed by oral appliance therapy (11.2%), while other interventions such as positional therapy, tonsillectomy, uvulopalatopharyngoplasty, and tongue-base surgery were each utilized by less than 7% of participants (Table 2).

Table 2 Alternative treatments used in patients adherent and non-adherent to PAP therapyReliability and factor structure

Internal consistency of the patient experience questionnaire was assessed using Cronbach’s alpha across the four domains (Table 3). The overall reliability varied between scales, with Cronbach’s alpha ranging from 0.677 to 0.915, indicating acceptable to excellent internal consistency. Factor analysis confirmed the underlying structure, with the Kaiser-Meyer-Olkin measure supporting sampling adequacy and Bartlett’s test confirming sufficient correlation among items (all domains p <. 001). Full statistical details, including item-total correlations and factor loadings, are provided in the supplementary material.

Table 3 Reliability and factor structure of questionnaire domains, including cronbach’s alpha for internal consistency, Kaiser-Meyer-Olkin (KMO) measure for sampling adequacy, and bartlett’s test of sphericity for factorabilityHealth attitudes and self-management

The average domain score was 3.82 ± 0.61. Participants strongly valued their health, with 93.8% rating “My health is important to me” as 4 or 5 (mean 4.68 ± 0.81). Active PAP users reported significantly higher reliance on medical aids compared to those who discontinued treatment (4.52 ± 0.98 vs. 3.64 ± 1.48, p <. 001). Health literacy was moderate, with 44.5% rating their health knowledge as high, representing values of 4 or 5 on the Likert scale (Fig. 1).

OSA care provision perceptions

With a mean domain score of 3.83 ± 1.06, family support emerged as particularly strong. Over 90% reported high family understanding and support for their OSA treatment. Physician support was also positive, with 77.9% agreeing their primary care physician took sleep apnea seriously. Only 52.2% felt they had their sleep apnea under control, with significantly lower ratings among those who discontinued PAP therapy (p <. 001). Notably, over 70% reported low stigma associated with their condition or treatment (Fig. 2).

OSA disease knowledge

This domain (mean 3.83 ± 1.09) revealed strong recognition of treatment importance, with over 90% acknowledging the importance of regular OSA treatment. Most participants demonstrated good disease understanding, with approximately 70% reporting high knowledge of both OSA and its treatment options. Significant concerns about OSA consequences were reported, with around 63% expressing fear of complications and 65% worried about daytime sleepiness impacts (Fig. 3).

Treatment experience

The mean domain score for “Treatment experience” was 3.23 ± 1.32. Understanding of PAP therapy mechanics was high (88.2% rated 4 or 5), and most participants (73.3%) found the therapy technically easy to use (Fig. 4). However, side effects were common, with 55.1% reporting PAP-related issues and 57.9% experiencing sleep initiation problems. Despite these challenges, only 21.1% reported reducing therapy use due to side effects, and overall satisfaction was moderate to high, with 59.1% rating their satisfaction as 4 or 5 (mean 3.53 ± 1.50).

Fig. 1

Likert scores (mean ± SD) for the domain Health attitudes and self-management

Fig. 2

Likert scores (mean ± SD) for the domain OSA care perceptions

Fig. 3

Likert scores (mean ± SD) for the domain OSA disease knowledge

Fig. 4

Likert scores (mean ± SD) for the domain Treatment experience

Predictors of patient satisfaction

Overall satisfaction with PAP therapy was moderate to high, with 59.1% rating their satisfaction as 4 or 5 (mean 3.53 ± 1.50). Patient satisfaction with PAP therapy showed significant associations with multiple factors. Satisfaction ratings negatively correlated with the use of alternative OSA treatments (τ = -0.274, p <. 001) and the total number of alternative treatments tried (r = -.270, p <. 001). Patients reporting higher satisfaction were less likely to pursue non-PAP alternatives. PAP satisfaction ratings also showed significant positive correlations with disease duration (τ = 0.187, p =. 008), duration of PAP therapy usage (τ = 0.185, p =. 011), and number of devices used (τ = 0.153, p =. 031).

The number of PAP masks tried was positively correlated with patient satisfaction, though this association did not reach statistical significance (τ = 0.130, p =. 063). No significant correlation was found between patient satisfaction and current PAP usage (τ = 0.113, p =. 115).

A hierarchical regression analysis was first conducted using domain-level scores, excluding patient satisfaction as the dependent variable, which revealed Treatment experience as the primary predictor of PAP therapy satisfaction (β = 0.826, 95% CI [0.720, 0.932], p <. 001), while other variables including OSA disease knowledge, OSA care provision perceptions, and Health attitudes and self-management did not significantly contribute to the model. Subsequent item-level analysis within the Treatment experience domain further explored the specific factors driving patient satisfaction, using stepwise multiple regression. The final model included four predictor items and was statistically significant (F(4, 88) = 69.375, p <. 001), explaining 75.9% of the variance in patient satisfaction (R² = 0.759, Adjusted R² = 0.748).

The items entered into the final model, in order of inclusion, were:

1.

Item 4.6 „I can integrate PAP therapy well into my routine” (β = 0.286, 95% CI [0.142, 0.431], p =. 001)

2.

Item 4.8 „I wake up at night due to PAP therapy” (reverse-coded, β = 0.273, 95% CI [0.126, 0.420], p <. 001)

3.

Item 4.3 „PAP therapy is effective” (β = 0.304, 95% CI [0.130, 0.478], p <. 001)

4.

Item 4.10 „I unconsciously remove the mask at night” (reverse-coded, β = 0.198, 95% CI [0.053, 0.343], p =. 007)

Item 4.6 was the strongest predictor, uniquely explaining 59.7% of the variance in reported patient satisfaction. The addition of item 4.8 in the second model increased the explained variance by 11% to a total of 70.7%. Items 4.3 and 4.10 in the third and fourth models further increased the explained variance by 3.1% and 2.1% respectively. The standardized beta coefficients indicate the relative importance of each predictor, with item 4.3 (β = 0.304) having the greatest impact, followed by item 4.6 (β = 0.286), item 4.8 (β = 0.273), and item 4.10 (β = 0.198).

Temporal patterns of PAP satisfaction predictors

To examine how satisfaction predictors evolve over treatment course, participants were stratified by disease duration into early stage (< 12 months, n = 17), intermediate stage (12–36 months, n = 43), and established stage (> 36 months, n = 88). Separate regression analyses were conducted for each group using the previously identified predictor variables.

In the early stage, satisfaction was primarily driven by therapy effectiveness (r =. 696, p <. 010) and showed strong negative correlation with nocturnal awakening (r=-.885, p <. 001). The model explained 85.5% of satisfaction variance. For intermediate stage patients, therapy effectiveness remained important (r =. 695, p <. 001), while routine integration emerged as a significant predictor (β = 0.444, 95% CI [0.240, 0.648], p <. 001). This model explained 71.3% of variance.

Among established users, therapy effectiveness maintained its significance (r =. 764, p <. 001), while the impact of mask removal decreased (r=-.572, p <. 001). The final model explained 72.1% of variance, with effectiveness remaining the dominant predictor (β = 0.508, 95% CI [0.295, 0.721], p <. 001). All temporal models showed good fit (R² >0.70), suggesting consistent determinants of satisfaction once patients progress beyond initial adaptation.