Table 1

Summary of studies included in this review

Olsen et al. [1]1488 patients with OSA from various studies
 1247 male
 241 female
 Age: 46–60 years
An overview of psychologically informed interventions for CPAP adherence
The HBM was used in prediction of both CPAP acceptance and adherence
Moderated regression techniquesApplying theoretical models to OSA research has substantially improved the understanding of psychological constructs in CPAP adherence
Using psychological and educational interventions for improving CPAP adherence is an understudied area of research; however, CBT-based interventions as well as motivational interventions addressing aspects of CPAP use are suggested as appropriate interventions for this population
Wild et al. [2]119 patients with OSAHS attending a sleep centre for overnight CPAP titration over an 8-month period
 94 male
 25 female
 Age: mean 51 years
Patients completed health value, health locus and self-efficacy prior to CPAP titrationThree psychological measures were used in accordance with Wallston’s learning theoryObjective adherence data measured using CPAP run-time clocks were collected
At 3-month follow-up, the mean CPAP use was 3.6±2.7 h per night in this population with 21 (18%) participants receiving some technical intervention for CPAP-related side-effects
Broström et al. [3]247 patients recruited from a CPAP clinic with three 1-h visits over a period of 2 weeks
 203 male
 44 female
 Age: mean 60 years
SECI was posted to perceive the effects on CPAP adherenceESS, OSAS severity variable and objective adherences to CPAP treatment were obtained from the medical recordsType D patients scored significantly higher (p<0.05–0.001) in 12 of the 15 side-effects compared with non-Type D patients
A total of 74 (30%) of the patients with OSAS (28% of the men versus 39% of the women) had Type D personality
Bollig [5]Review of multiple studiesClinical status outcomes were collected both before and after 3 months of therapy with questionnairesESS, MSLT and FOSQType D personality OSA patients reported a higher complaint of adverse effects from CPAP therapy and reported a higher rate of continued sleepiness than non-D personalities
In a discussion, 50% of patients with Type D personality used their CPAP <4 h per night, compared to 16% of the non-Type D participants
Dieltjens et al. [6]82 patients out of 113 with a known baseline type D scale started using MAD treatment between 2006/2009
 58 male
 24 female
 Age: mean 50±1 years
82 patients from 113 patients using MAD completed the DS14 Type D scale at baseline then follow up at 2 yearsSDB diagnosis started on a MAD device with demographic and clinical data including results from DS14, and a perceived side-effects and adherence postal questionnaireCharacteristics of the 82 patients: BMI 27.9±4.3 kg·m−2; AHI 17±13 events per h; ESS 10±5; VAS 6±2
Of the Type D patients, 45% discontinued MAD treatment with 15% of non-Type D reported treatment discontinuation
Moran et al. [4]63 participants diagnosed with OSAHS, with CPAP for 30 days, usage defined as >4 h per night on 70% of nights
 31 male
 32 female
 Age: mean 57.1 years
Predictors of adherence were identified including demographic variables and personality traitsMini-IPIP, BIS/BAS and WAYSOn ratings from the BIS/BAS, a raised BIS was a strong predictor of nonadherence (r= −0.452, p<0.01), followed by neuroticism
An elevated BIS score and neuroticism may indicate that personality factors are important in the determination of adherence to CPAP
Ekici et al. [11]The MMPI was used for 94 treatment-naïve snorers and OSA people
All patients with OSA and snorers were accepted with SDB (AHI >0 events per h)
The threshold of 5 events per h sleep was chosen to define both OSA and snorers
Admitted for overnight PSG with questionnairesPSG, MMPI, Fatigue scale, Adult ADHD scale, ESS, and SF-36OSA patients scored significantly higher on Hs scale (65.0±12.0 versus 58.4±7.9, p=0.01)
OSA patients compared to snorers have significantly higher rate of clinical elevation on both Pd (13.0 versus 0%, p=0.03) and Hs (26.1 versus 3.3%, p=0.01)
The results of the study may indicate that patients with OSAS, compared to snorers, presented with more Hs and Pd personality characteristics
Hayashida et al. [12]230 patients referred with OSAS with AHI >5 events per h; given CPAP
 230 male
 Age: 20–73 years
ESS, MMPI, SDS, age, BMI, sleep duration during the preceding month and AHISingle and multiple linear regression analyses were performed to estimate the association between the ESS and the other measures testedAge had negative association with ESS score (r= −0.245, p<0.001)
BMI (r=0.165, p=0.012), AHI (r=0.199, p=0.002), SDS (r=0.169, p=0.010), Hs (r=0.212, p=0.001), Hy (r=0.177, p=0.007), Pd (r=0.133, p=0.044), Pt (r=0.227, p=0.001), Sc (r=0.228, p<0.001) and Ma (r=0.163, p=0.014) all had a positive association with ESS score
There were several statistically clear and significant correlations (r≥0.5) among many MMPI variables:
 Hs versus D
 Hy, Pd, Pt and Sc
 D versus Pt, Sc and Si
 Hy versus Pd and Pt
 Pd versus Pt and Sc
 Pt versus Sc
Mols and Denollet [9]2813 patients total from 12 studies
Exclusion from the search included any cardiovascular population and any study with a negative affectivity or social inhibition personality
10-item standardised checklist for pre-defined criteria for systematic review on published papersA cross-sectional design analysing Type D personality amongst non-cardiovascular patient population in a medical populationPatients with sleep apnoea on treatment reported more side-effects of treatment and were less likely to adhere to treatment than their non-type counterparts (p<0.05–0.001)
Type D patients experienced their condition to be more disabling compared to non-Type D patients (40.5 versus 26.4; p=0.015), especially emotionally (p=0.007) and functionally (p=0.033)
Pierobon et al. [13]157 patients with OSAS from an obese population
 106 male
 51 female
 Age: 47±11.9 years
CBA 2.0, neuropsychological assessment, WAIS-R, verbal span test and PSGCross-sectional study
Patients were assessed using both psychological and neuropsychological variants
Patients reported with higher frequency, compared to the normal distribution, the presence of an extrovert personality trait and depressive behaviours: 15.9% of the patients minimised symptoms and denied distress, whereas 28.0% presented psychological disorders
Compared to the normative group, patients’ results were characterised as impaired with a higher percentage in short-term verbal memory (30.6%) and in short-term visual spatial memory (20.5%)
Moreover, 30.6% of patients were impaired in one cognitive function, 11.5% in two, 8.9% in three, and 8.2% in four or more cognitive functions
No significant relationships between psychological–neuropsychological data and clinical variables emerged
So et al. [14]88 patients with UARS.
 45 male
 43 female
 Age: 36.84±13.85 years
365 patients with OSAS
 299 male
 66 female
 Age: 49.52±11.79 years
AIS, PSQI and ESSOvernight PSG, AIS, PSQI, SCL-90-R and EPQThe URAS group scored significantly higher than the OSA group on the ESS, AIS and PSQI (p<0.001)
Scores of all SCL-90-R subscales in the UARS group were significantly higher than those in the OSA group (all were p<0.001, except somatisation, which was p=0.016)
Patients with UARS also scored lower on the EPQ-E (p=0.006) and EPQ-L (p<0.001), and showed higher scores on EPQ-P (p=0.002) and EPQ-N (neuroticism) (p<0.001) than those with OSA/OSAS
The ESS scores for UARS and OSAS were 10.2 and 6.8 (p<0.001)
Patients with UARS are more likely to have neurotic personalities and tend to be more anxious and sensitive than patients with OSAS (psychoticism 2.97±2.37 versus 2.14±1.76, neuroticism 16.57±4.46 versus 13.10±4.89)
Ayow et al. [15]8 patients recruited from a multisite sleep clinic, 4 who used CPAP for >5 h for 7 nights and 4 <1 h for 7 nights
 4 male
 4 female
 Age: 20–73 years
Demographic data, severity of OSA, extent of CPAP use, use of prescribed adjunct sedatives/hypnotics, and selected comorbidities known to influence CPAP adherenceSemistructured interviews took place in a private office in the clinic and lasted approximately 15–60 min
Questions asked about CPAP experience, CPAP use, influences for CPAP use/nonuse and biggest challenge for CPAP use
Perceived physical, psychological and social factors were found to influence both CPAP use and non-use
The way patients feel about themselves influences the ways in which they manage their OSA with or without CPAP
  • HBM: Health Belief Model; CBT: cognitive behavioural therapy; OSHAS: obstructive sleep apnoea–hypopnoea syndrome; SECI: Side-Effects of CPAP Inventory; ESS: Epworth Sleepiness Scale; OSAS: obstructive sleep apnoea syndrome; MSLT: Multiple Sleep Latency Test; FOSQ: Functional Outcomes of Sleep Questionnaire; MAD: mandibular advancement device; SDB: sleep disordered breathing; VAS: visual analogue scale for snoring; IPIP: International Personality Item Pool; BIS/BAS: behavioural inhibition system/behavioural activation system; WAYS: Ways of Coping; PSG: polysomnography; ADHD: attention deficit/hyperactivity disorder; SF-36: 36-item Short Form Survey; Hs: hypochondriasis; Pd: psychopathic deviate; SDS: Self-Rating Depression Scale; Hy: hysteria; Pt: psychasthenia; Sc: schizophrenia; Ma: hypomania; D: depression; Si: social introversion; CBA: Cognitive Behavioural Assessment; WAIS-R: Wechsler Adult Intelligence Scale Revised; UARS: upper airway resistance syndrome; AIS: Athens Insomnia Scale: PSQI: Pittsburgh Sleep Quality Index; SCL-90-R: Symptom Checklist-90 Revision; EPQ: Eysenck Personality Questionnaire; E: extroversion/introversion; L: lie; P: psychoticism; N: neuroticism.