Document Type


Date of this Version


Publication Source

Sleep Medicine Clinics


Large-scale randomized trials of positive airway pressure (PAP) efficacy have been largely negative yet PAP adherence was notably sub-optimal across the trials. To address this limitation, evidence-based PAP adherence protocols embedded within the larger trial protocol are recommended. The complexity of such protocols will be dependent on adequacy of resources, including funding and inclusion of behavioral scientist experts on the scientific team, and trial-specific considerations (e.g., target population) and methods. Recommendations for optimizing PAP adherence in large-scale trials are set forth that address rigor and reproducibility.

Copyright/Permission Statement

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. To view a copy of this license, visit or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.


Optimizing Adherence in Trials Author Deposited Pre-Print Accepted 5.28.20 by Sleep Medicine Clinics (Special Issue: Unraveling the Puzzle of Adherence in Sleep [Ed.] J. Bakker)

This work was supported in part by NIH/NIDDK (DK120051, PI Punjabi). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.


obstructive sleep apnea, continuous positive airway pressure, patient compliance, health behavior, telemedicine, health education, controlled clinical trial, behavioral economics

Included in

Nursing Commons



Date Posted: 27 July 2020