CPAP Users Prefer More Clinic Visits Over Fewer When Treating Sleep Apnea
A Japanese study reveals OSA patients value healthcare contact almost as much as symptom relief, challenging assumptions about treatment convenience.
Summary
A study of 161 Japanese CPAP users found that sleep quality improvement was the top treatment priority, accounting for 42% of decision weight. Surprisingly, patients actually preferred more frequent clinic visits, not fewer — and were willing to pay extra for that access. Poor CPAP adherers valued clinic contact most, likely viewing it as essential support. These findings challenge the common assumption that reducing in-person visits improves patient satisfaction. Instead, they suggest that for OSA management, human healthcare contact remains a valued component of care, and that treatment preferences differ meaningfully between patients who stick with CPAP and those who struggle with it. Clinicians may need to tailor follow-up intensity based on individual adherence patterns.
Detailed Summary
Obstructive sleep apnea affects hundreds of millions worldwide, and CPAP therapy remains the gold-standard treatment. Yet adherence is notoriously poor. Understanding what patients actually value in their treatment — beyond just efficacy — could be key to improving long-term outcomes and designing better care models.
Researchers in Japan conducted a discrete choice experiment with 161 CPAP-treated OSA patients at a community hospital. Participants chose between hypothetical treatment profiles that varied across five dimensions: sleep quality improvement, device usage frequency, side effect severity, clinic visit frequency, and monthly cost. This design allowed the team to quantify the relative importance of each attribute and estimate patients' willingness-to-pay (WTP).
Sleep quality improvement dominated all other preferences, accounting for 42.4% of decision weight, with patients willing to pay approximately ¥5,298 per month for meaningful symptom relief. The most counterintuitive finding was that patients showed a negative preference for reduced clinic visit frequency — in other words, they preferred seeing their doctor more, not less. They were willing to pay roughly ¥1,232 per month to maintain frequent clinic contact. Side effects did not reach statistical significance as a driver.
When stratified by adherence, poor adherers (using CPAP less than 70% of nights) showed particularly strong preference for clinic visits, suggesting they view regular healthcare contact as a critical support mechanism. Effect sizes for preference differences between adherence groups were large (Hedges' g of 1.84–1.93), though WTP comparisons were underpowered and not statistically significant.
For clinicians designing OSA care pathways, these findings challenge telehealth-first models that minimize in-person contact. Instead, a stratified approach — intensifying clinic contact for poor adherers — may better align with patient values. The study authors appropriately caution that results are exploratory and require replication in larger, adequately powered cohorts.
Key Findings
- Sleep quality improvement accounted for 42.4% of treatment preference weight among CPAP users.
- Patients paid a premium for more frequent clinic visits, not fewer — worth ~¥1,232/month.
- Poor CPAP adherers valued healthcare contact most, viewing visits as essential support.
- Side effect burden was not a statistically significant driver of treatment preference.
- Large effect sizes suggest distinct preference structures between high and low adherers.
Methodology
Discrete choice experiment conducted with 161 Japanese CPAP-treated OSA patients between August and October 2025 at a community hospital. Conditional logit models with Delta-method WTP estimation were used; adherence groups were compared via stratified models and effect size analysis.
Study Limitations
Summary is based on the abstract only, as the full text was not available. The sample was limited to 161 patients at a single Japanese community hospital, restricting generalizability to other populations and healthcare systems. WTP comparisons between adherence groups were substantially underpowered (post-hoc power 6–28%), making adherence-stratified findings hypothesis-generating rather than conclusive.
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