The interplay of dyadic adjustment, sleep quality, and CPAP adherence in OSAS: A cross-sectional study on illness perceptions and depressive symptoms

Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent sleep disorder characterized by recurrent upper airway obstructions, leading to adverse health outcomes. Continuous Positive Airway Pressure (CPAP) therapy is the primary treatment, yet adherence remains suboptimal due to psychosocial a nd relational factors. Bed partners often experience sleep disturbances and can influence the patient's treatment adherence. While dyadic adjustment is known to be associated with sleep quality, its role in OSAS management remains underexplored. Illness perceptions and depressive symptoms may mediate the relationship between dyadic adjustment, sleep, and CPAP adherence. This study explored: (1) how dyadic adjustment relates to sleep quality and illness perceptions in couples coping with OSAS; (2) whether illness perceptions mediate the link between dyadic adjustment and sleep disruption; (3) whether depressive symptoms mediate the association between CPAP adherence and relationship quality; and (4) how illness perceptions and depressive symptoms interrelate in OSA management. A cross-sectional study was conducted on 123 dyads (OSAS patients and their bed partners). Participants completed validated measures assessing dyadic adjustment, illness perceptions, sleep quality, depressive symptoms, and CPAP adherence. Actor-Partner Interdependence Mediation Models (APIMeM) and mediation analyses were applied. Higher dyadic adjustment was associated with less threatening illness perceptions, which in turn predicted fewer perceived sleep disturbances in patients (p < 0.001). No significant partner effects emerged for sleep quality. Higher CPAP use was directly associated with improved dyadic adjustment, with depressive symptoms mediating this relationship (β = 0.35, p < 0.001). Illness perceptions were positively correlated with depressive symptoms in both patients and partners. Dyadic adjustment and illness perceptions shape sleep experiences, while depressive symptoms influence the CPAP adherence-relationship quality link. The interplay between cognitive and emotional factors may have clinical relevance for treatment adherence and couple adaptation. Psychosocial interventions targeting relationship dynamics and illness representations may enhance both adherence and overall well-being, fostering a more supportive treatment environment.