{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:01:15Z","timestamp":1784890875603,"version":"3.55.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"8","funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006380","name":"Rehabilitation Research and Development Service","doi-asserted-by":"publisher","award":["IK2 RX002952"],"award-info":[{"award-number":["IK2 RX002952"]}],"id":[{"id":"10.13039\/100006380","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Rates of adherence to positive airway pressure (PAP) for sleep apnea are suboptimal. Though previous studies have identified individual factors associated with PAP nonadherence, few projects have investigated a wide range of possible barriers directly from the patient perspective. We examined the range of factors that patients identify as barriers to optimal use of PAP as well as the solutions most commonly offered by providers. We employed a mixed methods design including semistructured interviews and medical record review at a US Department of Veterans Affairs Medical Center. Thirty patients identified as nonadherent to PAP participated. Patients were asked to report on current sleep problems, reasons for nonadherence, and solutions proposed by providers. Chart review was used to identify untreated apnea severity, Epworth Sleepiness Scale score, therapy hours, and residual apnea severity. Patients described physical and psychological barriers to adherent use at approximately equal rates: Mask leaks and dry throat\/nose were common physical barriers, and anxiety\/claustrophobia and worsening insomnia were common psychological barriers. Untreated apnea severity, residual apnea severity, and daytime sleepiness were not associated with therapy hours. Solutions offered by providers most frequently addressed physical barriers, and solutions to psychological barriers were rarely proposed. The most common solution offered by providers was trying different masks. We recommend individualized assessment of each patient\u2019s barriers to use as well as increased involvement of behavioral health providers in sleep medicine clinics.<\/jats:p>","DOI":"10.1093\/tbm\/ibac040","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T18:06:12Z","timestamp":1654020372000},"page":"870-877","source":"Crossref","is-referenced-by-count":10,"title":["Barriers to positive airway pressure adherence among veterans with sleep apnea: a mixed methods study"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2841-4120","authenticated-orcid":false,"given":"Lizabeth A","family":"Goldstein","sequence":"first","affiliation":[{"name":"San Francisco Veterans Affairs Health Care System, Mental Health Service , San Francisco, CA ,","place":["USA"]},{"name":"San Francisco Veterans Affairs Health Care System, Research Service , San Francisco, CA ,","place":["USA"]},{"name":"University of California, San Francisco, Department of Psychiatry and Behavioral Sciences , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Purcell","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Health Care System, Integrative Health Service , San Francisco, CA ,","place":["USA"]},{"name":"University of California, San Francisco, Department of Social and Behavioral Sciences , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen F","family":"Sarmiento","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Health Care System, Medical Service , San Francisco, CA ,","place":["USA"]},{"name":"University of California, San Francisco, Department of Medicine , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas C","family":"Neylan","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Health Care System, Mental Health Service , San Francisco, CA ,","place":["USA"]},{"name":"University of California, San Francisco, Department of Psychiatry and Behavioral Sciences , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Maguen","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Health Care System, Mental Health Service , San Francisco, CA ,","place":["USA"]},{"name":"University of California, San Francisco, Department of Psychiatry and Behavioral Sciences , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"issue":"3","key":"2026072406050686300_CIT0001","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1378\/chest.130.3.780","article-title":"Prevalence of symptoms and risk of sleep apnea in the US population: results from the 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