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HOUSTON, Texas — Obstructive sleep apnea (OSA) not only affects the patient's health but also disrupts their partner's sleep, which can put strain on a relationship. 

New research suggests that greater adherence to positive airway pressure (PAP) therapy for OSA can lead to greater relationship satisfaction and lower levels of conflict — and that can be accomplished with a couples-based therapy called WePAP.

"Partners of individuals with sleep apnea are often considered the hidden casualties of sleep apnea, as their sleep is profoundly disrupted by the nocturnal symptoms," Wendy Troxel, PhD, senior behavioral scientist with RAND Corporation, and licensed clinical psychologist and adjunct professor at the University of Utah, Salt Lake City, Utah, told Medscape Medical News. 

The findings were presented at SLEEP 2024: 38th Annual Meeting of the Associated Professional Sleep Societies, and the study was also recently published online in the journal Sleep.

Shared Experience

Emerging research emphasizes the connection between sleep and relationship quality in healthy couples, but only limited research has examined how treatment for a sleep disorder can influence outcomes for both patients and partners.

Recognizing that couples' sleep is a shared experience, the researchers developed WePAP to help patients and their partners overcome challenges of adhering to PAP together.

Delivered via telehealth in three weekly sessions, WePAP educates patients and their partners on OSA and PAP treatment and offers techniques for improving sleep and strategies to manage problems that may arise. 

In a preliminary, randomized, controlled feasibility study of 32 couples, PAP adherence (defined as > 4 hours use per night, on average, over 3 months) was greater in WePAP participants than in a control group given just basic information (90% vs 77%). 

Improvements in sleep disturbance, depression, and quality of life were seen in both groups.

In a subsequent study of 36 OSA patients and their partners, greater PAP adherence was also associated with higher levels of relationship satisfaction and lower levels of relationship conflict for patients and their partners (P = .01), the researchers found. 

Higher patient sleep efficiency assessed using actigraphy was also associated with higher levels of patient- and partner-reported relationship satisfaction (P = .04).

Reducing Sleep Divorces?

Nearly 30 million adults in the United States are living with OSA, which is characterized by snoring and can be an obvious nuisance to their partners — impacting the quality of their relationship.

It's crucial to consider the importance of sleep when evaluating relationship status, said Troxel.

"No one is at their best when they aren't sleeping. In an age where we see couples going through 'sleep divorces' and roughly 50% of marriages ending in actual divorce, recognizing how healthy sleep can contribute to healthy relationships is imperative," she said.

Michael Breus, PhD, clinical psychologist and founder of TheSleepDoctor.com, who wasn't involved in the study, is not surprised by the results.

It "makes sense" that adherence to apnea treatment would lead to better relationships, he told Medscape Medical News.

First, the partner of the person with apnea, would likely "worry less about their partner's health since they are now being treated," Breus explained.

Second, it's "a lot less noisy when someone is treated for OSA. One study showed that sleeping next to a bed partner with undiagnosed apnea made the partner lose about 1 hour of sleep!" Breus noted.

The study was supported by a grant from the National Institutes of Health and had no commercial funding. Troxel and Breus had no relevant disclosures.