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Simon SL, Stephenson JJ, Haynes K, Kennedy ER, Frydman G, Amdur A, Parthasarathy S. The lived experience of positive airway pressure therapy in patients with obstructive sleep apnea across the lifespan: a qualitative study. J Clin Sleep Med 2024; 20:407-416. [PMID: 37882633 PMCID: PMC11019211 DOI: 10.5664/jcsm.10890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023]
Abstract
STUDY OBJECTIVES Although treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy is effective, adherence is often poor. Understanding the patient perspective is needed to inform adherence-promoting interventions. This qualitative study assessed the experiences, preferences, facilitators, and barriers surrounding PAP therapy for the management of OSA in patients from adolescence to older adulthood. METHODS Eligible participants ages 19 and older were identified from administrative health care claims; adolescent participants ages 12-18 and their parents/caregivers were identified via electronic health records of a tertiary sleep specialty clinic at a large children's hospital. Forty English-speaking patients and 10 parents of adolescents diagnosed with OSA and prescribed PAP therapy completed semistructured 60-minute telephone interviews conducted by a trained facilitator. Common themes and illustrative quotes were identified. RESULTS Themes around OSA diagnosis, initiating OSA treatment, learning about OSA/PAP, decision to start PAP, PAP benefits and challenges, and reasons for nonadherence were identified. Participants suggested design and delivery changes to improve PAP devices. Issues unique to adolescents and their parents were discussed. CONCLUSIONS The unique perspectives of patients regarding PAP therapy should be taken into consideration when developing interventions to increase PAP adherence and improve clinical care. Based on identified themes, opportunities for intervention may exist at all stages of care, from diagnosis to treatment initiation. Involving partners, parents, and other caregivers in PAP therapy may be beneficial for optimizing adherence. CITATION Simon SL, Stephenson JJ, Haynes K, et al. The lived experience of positive airway pressure therapy in patients with obstructive sleep apnea across the lifespan: a qualitative study. J Clin Sleep Med. 2024;20(3):407-416.
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Affiliation(s)
- Stacey L. Simon
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | | | | | - Adam Amdur
- American Sleep Apnea Association, Washington, DC
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Williams NJ, Grant AB, Butler M, Ebben M, Belisova-Gyure Z, Bubu OM, Jean-Louis G, Wallace DM. The effects of social support and support types on continuous positive airway pressure use after 1month of therapy among adults with obstructive sleep apnea. Sleep Health 2024; 10:69-74. [PMID: 38007302 DOI: 10.1016/j.sleh.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The relationship between perceived social support and continuous positive airway pressure remains understudied among individuals with obstructive sleep apnea. The aim of this prospective cohort study was to determine if baseline perceived social support and subtypes predict regular continuous positive airway pressure use after 1month of therapy. METHODS Adults with obstructive sleep apnea initiating continuous positive airway pressure therapy were recruited from sleep clinics in New York City. Demographics, medical history, and comorbidities were obtained from patient interview and review of medical records. Objective continuous positive airway pressure adherence data was collected at the first clinical follow-up. RESULTS Seventy-five participants (32% female; non-Hispanic Black 41%; mean age of 56 ± 14years) provided data. In adjusted analyses, poorer levels of overall social support, and subtypes including informational/emotional support, and positive social interactions were associated with lower continuous positive airway pressure use at 1month. Relative to patients reporting higher levels of support, participants endorsing lower levels of overall social support, positive social interaction and emotional/informational support had 1.6 hours (95% CI: 0.5,2.7, hours; p = .007), 1.3 hours (95% CI: 0.2,2.4; p = .026), and 1.2 hours (95% CI: 0.05,2.4; p = .041) lower mean daily continuous positive airway pressure use at 1month, respectively. CONCLUSION Focusing on social support overall and positive social interaction particularly, could be an effective approach to improve continuous positive airway pressure adherence in patients at risk of suboptimal adherence.
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Affiliation(s)
- Natasha J Williams
- NYU Grossman School of Medicine, Institute for Excellence in Health Equity, Department of Population Health, New York, New York, USA.
| | - Andrea Barnes Grant
- VA: Department of Veterans Affairs: New York Harbor HealthCare System, Brooklyn Campus, Brooklyn, New York, USA
| | - Mark Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Matthew Ebben
- Weill Cornell Medicine, Center for Sleep Medicine, New York, New York, USA
| | - Zuzana Belisova-Gyure
- VA: Department of Veterans Affairs: New York Harbor HealthCare System, New York Campus, New York, New York, USA
| | - Omonigho M Bubu
- NYU Grossman School of Medicine, Department of Psychiatry, New York, New York, USA
| | - Girardin Jean-Louis
- NYU Grossman School of Medicine, Department of Psychiatry, New York, New York, USA
| | - Douglas M Wallace
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA; Psychiatry and Behavioral Sciences, Neurology, Psychology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
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Fietze I, Rosenblum L, Ossadnik S, Gogarten JH, Zimmermann S, Penzel T, Laharnar N. Nocturnal positive pressure ventilation improves relationship satisfaction of patients with OSA and their partners. Sleep Med 2023; 111:191-198. [PMID: 37797413 DOI: 10.1016/j.sleep.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/26/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Continuous positive airway pressure (CPAP) ventilation is considered the therapeutic standard for obstructed sleep apnea (OSA). Therapy success may also be affected by the patient's bed partner. A questionnaire was developed and tested that measures the attitude of the bed partner towards CPAP therapy and relationship effects. METHODS A new questionnaire to capture bed partners' attitude towards CPAP mask therapy was used with an anonymous sample of 508 bed partners. Possible constructs underlying the attitude of the bed partner towards mask appearance have been investigated by means of a Principal Components Analysis. RESULTS The survey revealed bed partners' positive attitude towards their partner's CPAP therapy (over 90% of bed partners were happy with the therapy, over 75% would recommend the therapy). Importantly, the bed partners' satisfaction with the relationship increased significantly during CPAP therapy (before therapy: 49% were satisfied, after therapy initiation: 70%; p<.001). There was a strong correlation between support for CPAP therapy and improved sleep quality of bed partners (r = 0.352, p>.001). Furthermore, the validation of the questionnaire through principal components analysis revealed three major factors: Attitude (of the bed partner towards CPAP therapy), Looks (of the mask perceived by the bed partner), Intimacy (effect of CPAP therapy on relationship and intimacy). CONCLUSION Both, the OSA patient and the bed partner benefit from CPAP therapy. This is the first bed partner questionnaire - interviewing the bed partner alone and anonymously - that showed that CPAP therapy also positively influences the relationship. We recommend that the bed partner be involved in the CPAP treatment from the start of therapy.
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Affiliation(s)
- Ingo Fietze
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Lisa Rosenblum
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany.
| | - Sarah Ossadnik
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Jacob Henry Gogarten
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Sandra Zimmermann
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Thomas Penzel
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Naima Laharnar
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
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Cascais Costa C, Afreixo V, Cravo J. Impact of Obstructive Sleep Apnea Treatment on Marital Relationships: Sleeping Together Again? Cureus 2023; 15:e46513. [PMID: 37927636 PMCID: PMC10625457 DOI: 10.7759/cureus.46513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Objective We assess the impact of obstructive sleep apnea (OSA) treatment on the quality of marital relationships. Moreover, we evaluate the proportion of couples sleeping separately before treatment and whether there was any change after treatment began, which is still little explored in the literature. Methods A prospective study was conducted between April 2021 and April 2023, with users diagnosed with OSA in a level 2 hospital in Portugal. A questionnaire was applied before and after the start of treatment to both user and partner, which included questions on whether they slept together or separately, the disturbing factors of sleep quality, and satisfaction with the marital relationship. Statistical analysis was performed using R (version 4.2.2; R Development Core Team, Vienna, Austria). Results Seventy questionnaires were applied, 79% to male users. Forty-one percent of users reported that they slept at least once or twice a month separated from their spouse, and, of these, 41% always slept in separate rooms. The chief complaints of partners not sleeping together were snoring (86%), restless sleep (17%), and witnessed apnea (14%). After treatment, 72.4% started to sleep together again, with a statistically significant difference in the condition before and after intervention. Among all patients, 69% said that their personal lives had improved and, when asked the same question to their spouse, 74% recognized the benefit of therapy. Conclusion Starting treatment positively influenced the quality of the marital relationship of users and their partners, with a statistically significant proportion of couples sleeping together again.
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Affiliation(s)
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Aveiro, PRT
| | - João Cravo
- Department of Pulmonology, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
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Berg KA, Marbury M, Whaley MA, Perzynski AT, Patel SR, Thornton JD. Experiences with Continuous Positive Airway Pressure Among African American Patients and their Bed Partners. Behav Sleep Med 2023; 21:242-253. [PMID: 35583497 PMCID: PMC9672138 DOI: 10.1080/15402002.2022.2075365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
RATIONALE Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking. OBJECTIVES To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play. METHODS We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis. RESULTS 15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP. CONCLUSIONS African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners.
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Affiliation(s)
- Kristen A. Berg
- Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Marquisha Marbury
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Morgan A. Whaley
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Adam T. Perzynski
- Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
| | - Sanjay R. Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J. Daryl Thornton
- Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
- Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
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Joymangul JS, Sekhari A, Grasset O, Moalla N. Homecare interventions as a Service model for Obstructive sleep Apnea: Delivering personalised phone call using patient profiling and adherence predictions. Int J Med Inform 2023; 170:104935. [PMID: 36473408 DOI: 10.1016/j.ijmedinf.2022.104935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Obstructive Sleep Apnea (OSA) is a sleep disorder that leads to different pathologies like depression and cardiovascular problems. The first-line medical treatment for OSA is Continuous Positive Airway Pressure (CPAP) therapy. However, this therapy has the lowest adherence level when compared to other homecare therapies. Consequently, the main objective of this paper is to increase this adherence level with methods that can be replicated in a large number of patients. METHODS The Homecare Intervention as a Service model can build, verify, and deliver per-sonalised home care interventions. With the Homecare Intervention as a Service model, we build and provide on-demand personalised interventions according to the patient's needs. The 2 core components of this model are patient clustering and CPAP adherence predictions. To define the patient profiles and predict the adherence level, we apply the K-means and the Logistic Regression algorithm respectively. To support these algorithms, we use the CPAP monitoring data and qualitative data on the patients. RESULTS We demonstrate that there are 3 patient profiles (non-adherent, attempter, and adherent). We draw a comparison with multiple machine learning algorithms to predict CPAP adherence at 30, 60 and 90 days. In this case, the Logistic Regression gives the best results with a f1-score of 0.84 for30 days, 0.79 for 60 days and 0.76 for 90 days. These newly build profiles were to be used to deliver personalised phone call interventions. The phone call intervention shows an increase in adherence by 1.02 h/night for non-adherent patients and 0.69 h/night for attempter patients. CONCLUSIONS This is the first study in CPAP therapy that formalises the process of transforming raw data into effective home care interventions that can be delivered directly to the patients. In fact,it is the first time that both patient characterisation and predictions based on data are used to provide personalised patient management for CPAP therapy. Our model is flexible to be extended to new types of interventions and other homecare therapies.
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Baron KG, Troxel WM, Galloway S, Kharidia S, DeVettori G, Gilles A, Sundar KM, Watt MH. Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers. J Clin Sleep Med 2022; 18:2627-2634. [PMID: 35924667 PMCID: PMC9622986 DOI: 10.5664/jcsm.10180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Bed partners play a critical role in the treatment of obstructive sleep apnea and are affected by the treatment (or lack thereof) of their partner's obstructive sleep apnea, but few studies have included partners formally in treatment. In this qualitative study, we examine key stakeholder perspectives (patient, bedpartner, and sleep medicine provider) to inform the development of a novel, couples-based intervention to promote adherence to positive airway pressure (PAP) and sleep health among older adult couples. METHODS We conducted 3 focus group discussions with patients with obstructive sleep apnea/using PAP and their partners and 3 focus group discussions with sleep medicine providers. A standard interview guide was used to gather stakeholder input: (1) to understand interdependence of sleep among couples with sleep apnea; (2) to understand collaborative strategies that couples are currently using to address their sleep health challenges, including their perceptions of what is helpful vs not helpful; and (3) feasibility of the intervention design and delivery. Interviews were transcribed and thematically analyzed. RESULTS Participants (n = 25) included 9 patients, 7 partners, and 9 providers. Analysis of the discussion identified themes within the 3 topics addressed in the focus group discussions: (1) interdependence of sleep health among couples, (2) collaboration and other dyadic strategies for increasing PAP use, and (3) facilitators and barriers to a couples-based PAP adherence intervention. Results of the focus group discussions provided new insights into collaborative strategies that could be used to enhance the sleep health of both patients and partners. Patient/partners reported that a couples-based treatment could reduce common frustrations experienced by new PAP users, thereby benefiting their relationship. However, barriers to couples-based treatment included patients and partners feeling overwhelmed and reluctance to discuss intimacy. Providers recognized the benefits of involving partners but reported concern about exacerbating conflict in the couple. CONCLUSIONS Results indicate that couples and providers are enthusiastic about couples-based treatment that addresses their individual and dyadic sleep health challenges and identified important barriers that will need to be addressed to enhance uptake by clinicians and participation/retention of couples. CITATION Baron KG, Troxel WM, Galway S, et al. Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers. J Clin Sleep Med. 2022;18(11):2627-2634.
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Affiliation(s)
- Kelly G Baron
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Wendy M Troxel
- Division of Social and Economic Wellbeing, RAND Corporation, Pittsburgh, Pennsylvania
| | - Saydra Galloway
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Shilpi Kharidia
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Giulia DeVettori
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Allyson Gilles
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Krishna M Sundar
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
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Ye L, Mages MA, Jimison HB, Patel SR. Developing OurSleepKit: A Couple-focused mHealth Tool to Support Adherence to Positive Airway Pressure Treatment. Behav Sleep Med 2022; 20:695-705. [PMID: 34591739 PMCID: PMC8964838 DOI: 10.1080/15402002.2021.1984239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Existing interventions promoting positive airway pressure (PAP) adherence focus only on the diagnosed individual, despite the fact that partners are often the most impacted by obstructive sleep apnea (OSA), and are delivered mostly by health professionals, with limited success. The goal of this work is to develop a prototype of OurSleepKit, a couple-focused mobile health (mHealth) tool to coach mutual engagement and promote adherence to PAP treatment. METHODS We used an iterative participatory approach working with future end users of OurSleepKit to support the development of this prototype. We conducted a total of 14 semi-structured in-depth open-ended dyadic interviews with OSA patients and their partners. Phase 1 of the development was to inform key functions of an engaging tool. Phase 2 focused on developing functions to engage positive conversation in the dyad and obtained feedback for this initial prototype. RESULTS The OurSleepKit prototype was developed and demonstrated high acceptability and engagement. Three key functions included periodic assessments based on developmental stages of PAP treatment, a Coaching Board which provides customized and dynamically updated support content - primarily brief story-telling videos featuring real-life couples' experiences - and timely tailored prompts (for action, learning, and conversation) through push notifications in the evening to facilitate positive conversation in the dyad and offer in-the-moment support for PAP use. CONCLUSIONS Going beyond the traditional and prevailing view of PAP use as an individual phenomenon, OurSleepKit is a novel mHealth intervention engaging both the patient and partner holding great promise to promote PAP adherence.
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Affiliation(s)
- Lichuan Ye
- Bouvé College of Health Sciences School of Nursing, Northeastern University, Boston, MA, USA
| | | | - Holly B. Jimison
- Bouvé College of Health Sciences School of Nursing, Northeastern University, Boston, MA, USA
- Khoury College of Computer & Information Science, Northeastern University, Boston, MA, USA
| | - Sanjay R. Patel
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Rosa D, Perger E, Villa G, Bonetti L, Storti V, Cartabia E, Ledonne G, Lombardi C, Beatrice A, Amigoni C, Parati G. Pharmacotherapy for Obstructive Sleep Apnoea and Coupled Life: A Descriptive Phenomenological Study of a Complex Interaction. Healthcare (Basel) 2022; 10:1859. [PMID: 36292306 PMCID: PMC9601695 DOI: 10.3390/healthcare10101859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Obstructive Sleep Apnoea (OSA) is a common chronic sleep-related breathing disorder. Drug therapy is a recent approach to treating OSA, and no data is available regarding its effects on a couple's life. The aim of this study was to investigate the impact on couples' lives of a novel drug treatment for OSA. METHODS Participants of a trial on new drug therapy (reboxetine plus oxybutynin) for OSA were interviewed. The study was conducted using a descriptive phenomenological approach by Sundler et al. Results: Ten patients and six of their partners were recruited through a purposive sampling between February and April 2021. The results indicate that drug treatment of OSA had a favourable impact on the couples' lives. Pharmacotherapy improved self-reported sleep quality, as the absence of CPAP allows people to sleep closer to the bed partner and because the patient does not have to sleep in a forced position. Moreover, the couples developed teamwork from the beginning which appeared to be crucial during the trial, especially when some difficulties and adverse events occurred. CONCLUSIONS This study presents the presence of a positive closed loop that could be considered a predictor of adherence to drug therapy.
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Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
| | - Valeria Storti
- Department of Nursing, University of Milan, ASST Fatebenefratelli Sacco, Luigi Sacco Teaching Hospital, 20146 Milan, Italy
| | - Elisa Cartabia
- Neuromotor Rehabilitation Unit, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Giuseppina Ledonne
- Department of Nursing, University of Milan, ASST Fatebenefratelli Sacco, Luigi Sacco Teaching Hospital, 20146 Milan, Italy
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Albanesi Beatrice
- Department of Clinical and Molecular Medicine, University “La Sapienza”, 00185 Rome, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano, IRCCS, SITR Lombardia, 20149 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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Luyster FS, Ni Q, Lee K, Harrison C, Ramprasad VH, Soose RJ, Strollo PJ. Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment. J Clin Sleep Med 2022; 18:2207-2215. [PMID: 35689597 PMCID: PMC9435328 DOI: 10.5664/jcsm.10086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Upper airway stimulation (UAS) is an alternative treatment for obstructive sleep apnea that must be activated nightly. Although the implanted device offsets the mask- or pressure-related side effects often associated with continuous positive airway pressure therapy, some UAS recipients do not use the therapy consistently. This study qualitatively explored factors associated with UAS usage in obstructive sleep apnea patients. METHODS Semistructured interviews were conducted with 24 obstructive sleep apnea patients who received UAS treatment. Twelve patients were categorized as high users with mean usage of ≥ 4 hours/night and 12 were categorized as low users with < 4 hours/night or nonuse. Interviews explored patients' experiences regarding barriers and facilitators to UAS use and their advice for new UAS recipients. Demographic and clinical data including the Insomnia Severity Index and Generalized Anxiety Disorder Scale were collected. RESULTS Compared to high users, low users had higher levels of insomnia (mean Insomnia Severity Index: 3.6 vs 15.2, respectively) and anxiety (mean Generalized Anxiety Disorder Scale: 3.4 vs 6.9). High users reported more positive experiences with UAS treatment, such as improvements in symptoms and convenience of treatment, as facilitators of use. Low users tended to focus on the negative aspects of treatment, particularly stimulation-related discomfort and associated sleep disturbance. CONCLUSIONS Insomnia with or without anxiety contributes to differing patient-reported experiences in high vs low user groups, with increased insomnia symptoms among low users. Improved understanding of the specific barrier and facilitators of UAS adherence may drive better long-term use and more personalized management strategies, including concomitant insomnia treatment. CLINICAL TRIALS REGISTRATION Registry: ClinicalTrials.gov; Name: Stimulation Therapy for Apnea: Reporting Thoughts (START); URL: https://clinicaltrials.gov/ct2/show/NCT04768543; Identifier: NCT04768543. CITATION Luyster FS, Ni Q, Lee K, et al. Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment. J Clin Sleep Med. 2022;18(9):2207-2215.
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Affiliation(s)
- Faith S. Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Quan Ni
- Inspire Medical Systems, Inc., Minneapolis, Minnesota
| | - Kent Lee
- Inspire Medical Systems, Inc., Minneapolis, Minnesota
| | - Christine Harrison
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vaibhav H. Ramprasad
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ryan J. Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J. Strollo
- Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Aalaei S, Amini M, Mazaheri Habibi MR, Shahraki H, Eslami S. A telemonitoring system to support CPAP therapy in patients with obstructive sleep apnea: a participatory approach in analysis, design, and evaluation. BMC Med Inform Decis Mak 2022; 22:168. [PMID: 35754055 PMCID: PMC9235202 DOI: 10.1186/s12911-022-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background Continues positive airway pressure (CPAP) therapy is a gold standard treatment for moderate to severe cases of OSA (obstructive sleep apnea). The present research aimed to describe the analysis, design, and evaluation of a telemonitoring system to improve CPAP adherence in patients afflicted with OSA.
Methods The telemonitoring system was developed in five phases. In the exploratory phase, the body of related literature was reviewed. Then a need analysis was conducted through a focus group discussion with sleep medicine specialists and sales company representatives and an interview with patients. The third phase involved data integration. Then the content and system development were done based on the previous phases. Finally, usability and functionality tests were used to evaluate the system. Results The exploratory phase and the needs analysis were conducted by four sleep medicine specialists, two medical informatics specialists, six key figures of the sales companies, two system developers, and 46 patients in different phases. Based on the results obtained from the data integration phase, the telemonitoring system involved three main parts: a patient’s application, a doctor’s portal, a selling companies’ portal (operator’s portal) along with facilitating software for patients to send the CPAP data. Usability and functionality tests were given to 7 and 10 patients, respectively. The total number of usability issues reported by users in the evaluation process was 18, with an average of 2.5 issues per user. The installation problems, disrupted links and improper playing of videos were the main functionalities problems that were solved. Conclusion The telemonitoring system, as a means of communication between patients, doctors, and selling companies, can be used to support patients clinically and technically. It has the potential to improve CPAP adherence in patients with OSA.
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Affiliation(s)
- Shokoufeh Aalaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahnaz Amini
- Faculty of Medicine, Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hadi Shahraki
- Department of Computer Engineering, Faculty of Industry and Mining, University of Sistan and Baluchestan, Zahedan, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands. .,Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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12
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Rosa D, Amigoni C, Rimoldi E, Ripa P, Ligorio A, Fracchiolla M, Lombardi C, Parati G, Perger E. Obstructive Sleep Apnea and Adherence to Continuous Positive Airway Pressure (CPAP) Treatment: Let's Talk about Partners! Healthcare (Basel) 2022; 10:943. [PMID: 35628081 PMCID: PMC9141202 DOI: 10.3390/healthcare10050943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). The benefits of this therapy were studied and analyzed over time; patient adherence is often poor, as many factors negatively influence it. A topic that needs clarification is whether adherence to CPAP treatment in a patient with OSA is influenced by the behavior of a partner or spouse. METHODS A scoping review was conducted to evaluate the role of partner involvement in the CPAP treatment management in a patient with OSA. The research project was performed between August and September 2021 by consulting the main biomedical databases: CINHAL, Embase, PsycINFO, and PubMed. RESULTS Among 21 articles considered valid for our aim, 15 are qualitative studies, 5 are quantitative and 1 presents a mixed method. We identified several thematic areas and "key" elements, which are prevalent in the studies evaluated. CONCLUSIONS The presence of a partner promotes adherence to CPAP therapy in patients with OSA, resulting in ameliorating their overall quality of life. To increase CPAP adherence, a trained nurse could represent a reference figure to technically and emotionally support couples during the adaptation period and in the long term.
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Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano, IRCCS, SITR Lombardia, 20149 Milan, Italy;
| | - Elisa Rimoldi
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Paola Ripa
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Antonella Ligorio
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Miriam Fracchiolla
- Multimedica, IRCCS, Emergency Department, 20099 Sesto San Giovanni, Italy;
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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13
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Burns-Mullett C, Zhang Y. STOP-Bang Screening for Obstructive Sleep Apnea in Preoperative Patients: A Quality Improvement Project. J Perianesth Nurs 2022; 37:601-606. [DOI: 10.1016/j.jopan.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/29/2021] [Accepted: 11/01/2021] [Indexed: 10/18/2022]
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14
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Michalek-Zrabkowska M, Poreba R, Gac P, Frosztega W, Wojakowska A, Wieckiewicz M, Kanclerska J, Macek P, Wieckiewicz W, Mazur G, Martynowicz H. Telemetric Assessment of Continuous Positive Airways Pressure (CPAP) Effectiveness and Adherence in Obstructive Sleep Apnea during COVID-19 Pandemic. Biomedicines 2022; 10:biomedicines10051011. [PMID: 35625748 PMCID: PMC9138500 DOI: 10.3390/biomedicines10051011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023] Open
Abstract
Obstructive sleep apnea is the most common sleep-related breathing disorder. In the pandemic times of the new coronavirus SARS-CoV-2, CPAP (Continuous Positive Airway Pressure) therapy of obstructive sleep apnea became even more challenging. After the pandemic outbreak in March 2020, most CPAP treatment recommendations changed because of rising concerns about CPAP usage safety for patients and their families. Therefore, we examined the effectiveness of CPAP and adherence to the therapy of 149 adults with obstructive sleep apnea in the period of two years from 4 March 2019 to 3 March 2021 (before pandemic breakout and during the first year of pandemic). Data on CPAP parameters and adherence to therapy were obtained via a telemetric system. Together, our results demonstrated that the COVID-19 pandemic had no significant impact on CPAP therapy parameters and adherence in whole study group. However, detailed analysis acknowledged that some demographic and clinical features influenced CPAP therapy. The results showed that across subgroups of patients differentiated on the basis of age, gender, co-existing diabetes mellitus, or hypertension, the COVID-19 pandemic seemed to affect CPAP effectiveness. Our results provide a good starting point for discussion on CPAP therapy recommendations during pandemic times.
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Affiliation(s)
- Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Pawel Gac
- Division of Environmental Health and Occupational Medicine, Department of Population Health, Wroclaw Medical University, 7 Mikulicza-Radeckiego St., 50-345 Wroclaw, Poland
- Correspondence: ; Tel.: +48-71-784-15-01
| | - Weronika Frosztega
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland;
| | - Justyna Kanclerska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Wlodzimierz Wieckiewicz
- Department of Prostodontics, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
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15
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Ye L, Li W, Willis DG. Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners. J Clin Sleep Med 2022; 18:835-841. [PMID: 34672944 PMCID: PMC8883110 DOI: 10.5664/jcsm.9738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a prevalent and debilitating condition that is significantly underdiagnosed. The majority of adults sleep with someone-a partner. Partners can play a significant role in the patient's OSA diagnosis. The goal of this work is to describe facilitators and barriers to OSA diagnosis as discussed by patients with OSA and their partners. METHODS This was a qualitative secondary analysis with results drawn from 20 dyadic interviews, conducted 1 couple at a time, in 20 newly diagnosed adult patients with OSA and their partners. Qualitative interview data were analyzed using conventional content analysis. RESULTS Facilitators of OSA diagnosis were partners pushing patients to seek care, patients actively seeking care, and care providers identifying the patient's risk of OSA. Barriers to OSA diagnosis were patients' lack of serious attention to symptoms, patients' negative perceptual framing of diagnosis and treatment of OSA, and poor coordination of health care services. CONCLUSIONS We recommend engaging partners in the OSA diagnosis and developing educational and behavioral interventions to raise public awareness about OSA. It is important to educate clinicians on atypical presentations of OSA. Further investigation is needed to evaluate the impact of health care services on OSA diagnosis. CITATION Ye L, Li W, Willis DG. Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners. J Clin Sleep Med. 2022;18(3):835-841.
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Affiliation(s)
- Lichuan Ye
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts,Address correspondence to: Lichuan Ye, PhD, RN, School of Nursing, Bouvé College of Health Sciences, Northeastern University, 207c Robinson Hall, 360 Huntington Avenue, Boston, MA 02115; Tel: (617) 373-2582;
| | - Winnie Li
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Danny G. Willis
- Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, Missouri
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16
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Tu AY, Crawford MR, Dawson SC, Fogg LF, Turner AD, Wyatt JK, Crisostomo MI, Chhangani BS, Kushida CA, Edinger JD, Abbott SM, Malkani RG, Attarian HP, Zee PC, Ong JC. A randomized controlled trial of cognitive behavioral therapy for insomnia and PAP for obstructive sleep apnea and comorbid insomnia: effects on nocturnal sleep and daytime performance. J Clin Sleep Med 2022; 18:789-800. [PMID: 34648425 PMCID: PMC8883096 DOI: 10.5664/jcsm.9696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study examines the impact of cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) therapy for comorbid insomnia and sleep apnea on nocturnal sleep and daytime functioning. METHODS A partial factorial design was used to examine treatment pathways with CBT-I and PAP and the relative benefits of each treatment. One hundred eighteen individuals with comorbid insomnia and sleep apnea were randomized to receive CBT-I followed by PAP, self-monitoring followed by CBT-I concurrent with PAP, or self-monitoring followed by PAP only. Participants were assessed at baseline, PAP titration, and 30 and 90 days after PAP initiation. Outcome measures included sleep diary- and actigraphy-measured sleep, Flinders Fatigue Scale, Epworth Sleepiness Scale, Functional Outcome of Sleep Questionnaire, and cognitive emotional measures. RESULTS A main effect of time was found on diary-measured sleep parameters (decreased sleep onset latency and wake after sleep onset; increased total sleep time and sleep efficiency) and actigraphy-measured sleep parameters (decreased wake after sleep onset; increased sleep efficiency) and daytime functioning (reduced Epworth Sleepiness Scale, Flinders Fatigue Scale; increased Functional Outcome of Sleep Questionnaire) across all arms (all P < .05). Significant interactions and planned contrast comparisons revealed that CBT-I was superior to PAP and self-monitoring on reducing diary-measured sleep onset latency and wake after sleep onset and increasing sleep efficiency, as well as improving Functional Outcome of Sleep Questionnaire and Flinders Fatigue Scale compared to self-monitoring. CONCLUSIONS Improvements in sleep and daytime functioning were found with PAP alone or concomitant with CBT-I. However, more rapid effects were observed on self-reported sleep and daytime performance when receiving CBT-I regardless of when it was initiated. Therefore, concomitant treatment appears to be a favorable approach to accelerate treatment outcomes. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Multidisciplinary Approach to the Treatment of Insomnia and Comorbid Sleep Apnea (MATRICS); URL: https://clinicaltrials.gov/ct2/show/NCT01785303; Identifier: NCT01785303. CITATION Tu AY, Crawford MR, Dawson SC, et al. A randomized controlled trial of cognitive behavioral therapy for insomnia and PAP for obstructive sleep apnea and comorbid insomnia: effects on nocturnal sleep and daytime performance. J Clin Sleep Med. 2022;18(3):789-800.
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Affiliation(s)
- Alice Y. Tu
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan R. Crawford
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Spencer C. Dawson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Louis F. Fogg
- College of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Arlener D. Turner
- Center for Translational Sleep and Circadian Sciences, Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida
| | - James K. Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | | | - Bantu S. Chhangani
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Clete A. Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Jack D. Edinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Sabra M. Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roneil G. Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Neurology Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | - Hrayr P. Attarian
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason C. Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Nox Health, Suwanee, Georgia,Address correspondence to: Jason C. Ong, PhD, Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Room 1004, Chicago, IL 60611;
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17
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Sullivan J, Pasquale C, Clark B, Malanga E, Martinez S, Mannino D, Stepnowsky C. Outcomes Important to Patients Diagnosed with Both COPD and Sleep Apnea: Findings from the O2VERLAP Study Focus Groups. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:45-54. [PMID: 34915602 PMCID: PMC8893966 DOI: 10.15326/jcopdf.2021.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Few studies have asked chronic obstructive pulmonary disease (COPD) -obstructive sleep apnea (OSA) overlap syndrome patients what outcomes of continuous positive airway pressure (CPAP) therapy are important to them, while also considering their self-reported CPAP adherence barriers and facilitators. This study conducted a series of focus groups to learn about those issues with the goal of applying these findings to the design of a larger Patient-Centered Outcomes Research Institute-funded scientific study, the O2VERLAP Study. METHODS People previously diagnosed with both COPD and OSA, who were current or recent past users of the standard therapy for each condition (i.e., supplemental oxygen and CPAP, respectively), were included. Three qualitative focus groups were run using different communication modalities: (1) teleconference (audio only), (2) in-person, and (3) web-based. RESULTS The focus groups included a total of 17 participants. The telephone and online focus groups resulted in more relevant and content-rich transcripts, while the in-person focus groups had far fewer excerpts able to be coded. Participants were most concerned about mask fit and comfort. Other key factors affecting CPAP use included nasal dryness and issues concerning insurance. The most important outcome to patients was daytime functioning. DISCUSSION This work found that telephone and web-based qualitative focus groups resulted in greater topical discussions than in-person focus groups, likely due to the customary socializing that occurs in-person. The study identified: (1) CPAP use barriers and facilitators that helped guide intervention development for the larger study and, (2) daytime functioning as the most important outcome for patients.
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Affiliation(s)
- Jamie Sullivan
- COPD Foundation, Miami, Florida, United States
- * Affiliation at the time the study was conducted
| | | | - Bill Clark
- COPD Foundation, Miami, Florida, United States
| | | | | | - David Mannino
- COPD Foundation, Miami, Florida, United States
- University of Kentucky, Lexington, Kentucky, United States
| | - Carl Stepnowsky
- University of California San Diego, La Jolla, California, United States
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18
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A Health Communication Assessment of Web-based Obstructive Sleep Apnea Patient Education Materials. ATS Sch 2022; 3:48-63. [PMID: 35634002 PMCID: PMC9131885 DOI: 10.34197/ats-scholar.2021-0055oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Objective Methods Results Conclusion
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19
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Khan NNS, Todem D, Bottu S, Badr MS, Olomu A, Olomu A. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med 2022; 18:181-191. [PMID: 34270409 PMCID: PMC8807929 DOI: 10.5664/jcsm.9534] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES The aim of the Improving CPAP Adherence Program was to assess the impact of a multidimensional treatment framework based on shared decision-making, patient activation, and caregiver engagement on improving long-term positive airway pressure (PAP) adherence in patients newly diagnosed with obstructive sleep apnea. METHODS In this pilot study, patients aged ≥ 18 years with a new obstructive sleep apnea diagnosis who qualified for PAP treatment and lived with a caregiver were randomly assigned to receive either the multidimensional treatment (intervention, n = 28) or unrelated education (control group, n = 32). All patients and their caregiver participated in a group visit. The intervention group attended 4 structured sessions: interactive education, peer coaching, hands-on experience, and a semistructured motivational interview. The control group was educated on physical activity and lifestyle only. Objective PAP adherence data were obtained at baseline (day that they received PAP machine to group visit), group visit to 3 months, and 3-6 months. RESULTS In an age-adjusted model, the mean daily use of PAP increased significantly over the 3 time periods (P = .03). Intervention-arm participants gained a mean 1.23 hours (95% confidence interval, 0.33-2.13) in PAP mean daily use between 3 and 6 months vs those in the control arm (P = .008). We saw no difference in the percentage of PAP adherence across time between the 2 arms. CONCLUSIONS A multifaceted patient-centered intervention with caregiver engagement improved PAP adherence vs control levels, a beneficial effect sustained for the 6 months. Our findings suggest that caregivers, with the appropriate training, can improve patients' PAP adherence by providing a socially supportive environment. CITATION Khan NNS, Todem D, Bottu S, Badr MS, Olomu A. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2022;18(1):181-191.
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Affiliation(s)
- Nazia Naz S. Khan
- Department of Medicine, Michigan State University, East Lansing, Michigan,Address correspondence to: Nazia Naz S. Khan, MD, MS, Department of Medicine, Michigan State University, 788 Service Road, Clinical Center B-325, East Lansing, MI 48824; Office Tel: 517-353-3730; Office Fax: 517-432-1326;
| | - David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Shireesha Bottu
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - M. Safwan Badr
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, Harper University Hospital, Wayne State University School of Medicine, Detroit, Michigan
| | - Adesuwa Olomu
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Adesuwa Olomu
- Department of Medicine, Michigan State University, East Lansing, MI
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20
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Rapelli G, Pietrabissa G, Angeli L, Bastoni I, Tovaglieri I, Fanari P, Castelnuovo G. Assessing the needs and perspectives of patients with obesity and obstructive sleep apnea syndrome following continuous positive airway pressure therapy to inform health care practice: A focus group study. Front Psychol 2022; 13:947346. [PMID: 36160561 PMCID: PMC9500455 DOI: 10.3389/fpsyg.2022.947346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to investigate the lived experience in patients with obstructive sleep apnea syndrome (OSAS) and comorbid obesity following after continuous positive airway pressure (CPAP) therapy made with the disease the device, and to identify barriers and facilitators to the use of CPAP to improve rehabilitation provision and aid in disease self-management. Methods Qualitative research was conducted using three focus groups with a representative sample of 32 inpatients (37% female) undergoing a 1-month pulmonary rehabilitation program at the IRCSS Istituto Auxologico Italiano San Giuseppe Hospital, Verbania, Italy. The focus groups were recorded on tape, and contemporaneous notes were made. The tapes were transcribed verbatim, and Interpretative Phenomenological Analysis was used to develop themes. Results Six main themes were extracted: (1) Living the diagnosis as a shock; (2) You should not sleep on it: the importance of prevention; (3) The adjustment to CPAP; (4) Barriers and facilitators to the use of CPAP; (5) Three in a bed; and (6) The relationship with the healthcare system. Conclusion Results of this study suggest potential avenues for interventions to increase adherence to CPAP, including the provision of information and continued support. Individual counseling providing strategies aimed at helping the person to cope with the emotional problem and relational difficulties associated with the use of CPAP, and at strengthening self-efficacy and self-management skills are also encouraged for optimal care during the rehabilitation program.
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Affiliation(s)
- Giada Rapelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Licia Angeli
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Ilaria Bastoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Ilaria Tovaglieri
- Pulmonary Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Paolo Fanari
- Pulmonary Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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21
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Decker AN, Fischer AR, Gunn HE. Socio-Ecological Context of Sleep: Gender Differences and Couples' Relationships as Exemplars. Curr Psychiatry Rep 2022; 24:831-840. [PMID: 36401678 PMCID: PMC9676909 DOI: 10.1007/s11920-022-01393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW We summarized recent findings on insufficient sleep and insomnia, two prominent sleep issues that impact public health. We demonstrate the socio-ecologial impact of sleep health with findings on gender and couples' relationships as exemplars. RECENT FINDINGS Robust gender differences in sleep duration and insomnia are due to biological and socio-ecological factors. Gender differences in insufficient sleep vary by country of origin and age whereas gender differences in insomnia reflect minoritized identities (e.g., sexual, gender). Co-sleeping with a partner is associated with longer sleep and more awakenings. Gender differences and couples' sleep were affected by intersecting social and societal influences, which supports a socio-ecological approach to sleep. Recent and seminal contributions to sleep health highlight the importance of observing individual sleep outcomes in a socio-ecological context. Novel methodology, such as global measures of sleep health, can inform efforts to improve sleep and, ultimately, public health.
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Affiliation(s)
- Andrea N. Decker
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
| | - Alexandra R. Fischer
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
| | - Heather E. Gunn
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
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Effect of Obstructive Sleep Apnea on the Risk of Injuries-A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413416. [PMID: 34949031 PMCID: PMC8707297 DOI: 10.3390/ijerph182413416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) has been reported to increase the risk of motor vehicle accidents. However, only few studies have investigated the effects of OSA on overall risk injury. The aim of study is to investigate whether OSA increases the risk of overall injury. The data were collected during 2000–2015 from Taiwan’s National Health Insurance Research Database. A total of 8901 individuals diagnosed with OSA were inpatients, or outpatients at least three times were enrolled. Finally, 6915 participants with OSA were included as the study cohort. We matched the study cohort with a comparison cohort, at a ratio of 1:4. Cox proportional hazards regression was used to analyse the association between OSA and overall injury. Patients with OSA had 83.1% increased risk of overall injury, compared to non-OSA individuals [adjusted hazards ratio (HR) = 1.831, confidence interval (CI) = 1.674–2.020, p < 0.001]. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 2.014; CI = 1.842–2.222, p < 0.001). Patients with OSA were at a higher risk of falls, traffic injury, poisoning, suffocation, suicide, and abuse or homicide than non-OSA individuals, with falls and traffic injury as the leading causes of injuries. The data demonstrated that patients with OSA have a higher risk of overall injury. The study results can be a reference for developing injury prevention strategies in the future. The general population and clinicians should have more awareness regarding OSA and its negative effects on injury development.
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Laursen DH, Rom G, Banghøj AM, Tarnow L, Schou L. Improving Diabetes Self-management by Providing Continuous Positive Airway Pressure Treatment to Patients With Obstructive Sleep Apnea and Type 2 Diabetes: Qualitative Exploratory Interview Study. JMIR Form Res 2021; 5:e27062. [PMID: 34283032 PMCID: PMC8335608 DOI: 10.2196/27062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/03/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is a high prevalence of unexplained and unexplored obstructive sleep apnea (OSA) among patients with type 2 diabetes. The daytime symptoms of OSA include severe fatigue, cognitive problems, a decreased quality of life, and the reduced motivation to perform self-care. These symptoms impair the management of both diabetes and daily life. OSA may therefore have negative implications for diabetes self-management. Continuous positive airway pressure (CPAP) therapy is used to treat OSA. This treatment improves sleep quality, insulin resistance, and glycemic control. Although the benefits of using CPAP as a treatment for OSA are clear, the noncompliance rate is high, and the evidence for the perceived effect that CPAP treatment has on patients with type 2 diabetes and OSA is poor. Objective The purpose of this study was to analyze the impacts that comorbid diabetes and OSA have on the daily lives of older adults and to investigate the perceived effect that CPAP treatment for OSA has on patients’ diabetes self-management. Methods A qualitative follow-up study that involved in-depth, semistructured dyad interviews with couples before and after CPAP treatment (N=22) was conducted. Patients were recruited from the Hilleroed Hospital in Denmark and were all diagnosed with type 2 diabetes, aged >18 years, and had an apnea-hypopnea index of ≥15. All interviews were coded and analyzed via thematic analysis. Results The results showed that patients and their partners did not consider OSA to be a serious disorder, as they believed that OSA symptoms were similar to those of the process of aging. Patients experienced poor nocturnal sleep, took frequent daytime naps, exhibited reduced cognitive function, and had low levels of physical activity and a high-calorie diet. These factors negatively influenced their diabetes self-management. Despite the immediate benefit of CPAP treatment, most patients (11/12, 92%) faced technical challenges when using the CPAP device. Only the patients with severe OSA symptoms that affected their daily lives overcame the challenges of using the CPAP device and thereby improved their diabetes self-management. Patients with less severe symptoms rated CPAP-related challenges as more burdensome than their symptoms. Conclusions If used correctly, CPAP has the potential to significantly improve OSA, resulting in better sleep quality; improved physical activity; improved diet; and, in the end, better diabetes self-management. However, there are many barriers to undergoing CPAP treatment, and only few patients manage to overcome these barriers and comply with correct treatment.
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Affiliation(s)
| | - Gitte Rom
- Institute of Nursing, University College Copenhagen, Copenhagen, Denmark
| | | | - Lise Tarnow
- Department of Endocrinology and Nephrology, Hillerød Hospital, Hillerød, Denmark.,Steno Diabetes Center Sjælland, Holbæk, Denmark
| | - Lone Schou
- Institute of Nursing, University College Copenhagen, Copenhagen, Denmark
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Chou MSH, Ting NCH, El-Turk N, Harrington Z, Dobler CC. Treatment burden experienced by patients with obstructive sleep apnoea using continuous positive airway pressure therapy. PLoS One 2021; 16:e0252915. [PMID: 34097721 PMCID: PMC8183990 DOI: 10.1371/journal.pone.0252915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Little is known about the treatment burden experienced by patients with obstructive sleep apnoea (OSA) who use continuous positive airway pressure (CPAP) therapy. PARTICIPANTS 18 patients (33.3% males, mean age 59.7±11.8 years) with OSA who use CPAP therapy were interviewed. METHODS Patients treated with CPAP for OSA at a tertiary hospital outpatient clinic in Sydney, Australia, were invited to participate in an interview in person or via phone. Semi-structured interviews were used to explore the treatment burden associated with using CPAP. The interviews were recorded, transcribed, and analysed using NVivo 12 qualitative analysis software. RESULTS Four categories of OSA-specific treatment burden were identified: healthcare tasks, consequences of healthcare tasks, exacerbating and alleviating factors of treatment burden. Participants reported a significant burden associated with using CPAP, independently of how frequently they used their device. Common sources of their treatment burden included attending healthcare appointments, the financial cost of treatment, lifestyle changes, treatment-related side effects and general discomfort. CONCLUSIONS This study demonstrated that there is a significant treatment burden associated with the use of CPAP, and that treatment non-adherence is not the only consequence of treatment burden. Other consequences include relationship burden, stigma and financial burden. It is important for physicians to identify other negative impacts of treatment burden in order to optimise the patient experience.
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Affiliation(s)
- Michael S. H. Chou
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Natasha C. H. Ting
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Nicole El-Turk
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Zinta Harrington
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Claudia C. Dobler
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- Institute for Evidence-Based Healthcare, Bond University and Gold Coast University Hospital, Gold Coast, QLD, Australia
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Brown A, Jones S, Perez-Algorta G. Experiences of Using Positive Airway Pressure for Treatment of Obstructive Sleep Apnoea: A Systematic Review and Thematic Synthesis. Sleep 2021; 44:6286002. [PMID: 34043010 DOI: 10.1093/sleep/zsab135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/28/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Sub-optimal use of positive airway pressure (PAP) to treat obstructive sleep apnoea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. METHODS PsycINFO, MEDLINE, CINAHL and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analysed were included. Papers were critically appraised using the CASP qualitative checklist to generate a "hierarchy of evidence". Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS 25 papers reporting on over 398 people's experiences were analysed to generate 4 themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. CONCLUSIONS The findings highlight the applicability of a biopsychosocial understanding to PAP use. This metasynthesis gave voice to user experiences, revealing barriers to PAP use at a healthcare service level across the world, and suggests ways services can address these barriers.
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CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis. J Clin Med 2021; 10:jcm10050936. [PMID: 33804319 PMCID: PMC7957656 DOI: 10.3390/jcm10050936] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/16/2022] Open
Abstract
The nationwide claims data lake for sleep apnoea (ALASKA)—real-life data for understanding and increasing obstructive sleep apnea (OSA) quality of care study—investigated long-term continuous positive airway pressure (CPAP) termination rates, focusing on the contribution of comorbidities. The French national health insurance reimbursement system data for new CPAP users aged ≥18 years were analyzed. Innovative algorithms were used to determine the presence of specific comorbidities (hypertension, diabetes and chronic obstructive pulmonary disease (COPD)). Therapy termination was defined as cessation of CPAP reimbursements. A total of 480,000 patients were included (mean age 59.3 ± 13.6 years, 65.4% male). An amount of 50.7, 24.4 and 4.3% of patients, respectively, had hypertension, diabetes and COPD. Overall CPAP termination rates after 1, 2 and 3 years were 23.1, 37.1 and 47.7%, respectively. On multivariable analysis, age categories, female sex (1.09 (1.08–1.10) and COPD (1.12 (1.10–1.13)) and diabetes (1.18 (1.16–1.19)) were significantly associated with higher CPAP termination risk; patients with hypertension were more likely to continue using CPAP (hazard ratio 0.96 (95% confidence interval 0.95–0.97)). Therapy termination rates were highest in younger or older patients with ≥1 comorbidity. Comorbidities have an important influence on long-term CPAP continuation in patients with OSA.
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27
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D'Rozario AL, Galgut Y, Crawford MR, Bartlett DJ. Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults. Sleep Med Clin 2021; 16:101-124. [PMID: 33485523 DOI: 10.1016/j.jsmc.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Continuous positive airway pressure (PAP) is still the most efficacious treatment for obstructive sleep apnea when used effectively. Since the availability of PAP 39 years ago there have been considerable technological advances, such as quieter, lighter and smaller machines with better humidification. However, adherence to treatment is still a major problem. This article reviews studies published on behavioral interventions aimed at improving the uptake and maintenance of PAP treatment (January 2016-February 2020). It discusses underlying factors in the poor uptake and discontinuation of treatment and the role of qualitative research to better understand the perspective of the patients.
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Affiliation(s)
- Angela L D'Rozario
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Level 2, Building D17, Johns Hopkins Drive, Camperdown, New South Wales 2050, Australia; Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney.
| | - Yael Galgut
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
| | - Megan R Crawford
- The University of Strathclyde, Graham Hills Building, 50 George Street, Glasgow G1 1QE, UK
| | - Delwyn J Bartlett
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney
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Sharma M, Chandra A, Toth R, Nahar VK. Utility of Multi-Theory Model (MTM) to Explain the Intention for PAP Adherence in Newly Diagnosed Sleep Apnea Patients. Nat Sci Sleep 2021; 13:263-271. [PMID: 33688285 PMCID: PMC7935343 DOI: 10.2147/nss.s294183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The objective of this study was to assess the utility of a fourth-generation multi-theory model (MTM) in explaining the intention for initiation and sustenance of PAP adherence among newly diagnosed sleep apnea patients. PATIENTS AND METHODS For this cross-sectional study, data were collected at a private sleep center located in the Southeastern United States. A total of 138 newly diagnosed patients with sleep apnea who had been prescribed PAP therapy completed a valid and reliable 41-item MTM instrument. Stepwise multiple regression modeling was conducted to assess MTM based explanatory variables of PAP adherence in this study sample. RESULTS MTM constructs namely participatory dialogue (β = 0.17, p = 0.014), behavioral confidence (β = 0.48, p < 0.001), and changes in the physical environment (β = 0.26, p = 0.001) were statistically significant predictors of the intention for initiation of PAP therapy and accounted for 53.5% of the variance. Emotional transformation (β = 0.57, p < 0.001), changes in the social environment (β = 0.16, p = 0.016), and practice for change (β = 0.16, p = 0.047) were statistically significant predictors of the intention for sustenance of PAP therapy and accounted for 60.6% of the variance. CONCLUSION The MTM was found to be a promising theoretical model in explaining the intention for initiation and sustenance of PAP therapy.
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Affiliation(s)
- Manoj Sharma
- Department of Environmental & Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Anuj Chandra
- Advanced Center for Sleep Disorders, Chattanooga, TN, USA
| | - Ryan Toth
- Advanced Center for Sleep Disorders, Chattanooga, TN, USA
| | - Vinayak K Nahar
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Preventive Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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29
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Watach AJ, Hwang D, Sawyer AM. Personalized and Patient-Centered Strategies to Improve Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Patient Prefer Adherence 2021; 15:1557-1570. [PMID: 34285474 PMCID: PMC8286071 DOI: 10.2147/ppa.s264927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder characterized by repeated pauses in breathing during sleep, is effectively treated with positive airway pressure (PAP) therapy. The magnitude of improvements in daily functioning and reduced negative health risks are dependent on maintaining PAP adherence, which is a significant challenge. Evidence-based interventions to improve PAP use are not easily translated to clinical practice because they are labor-intensive and require specialty expertise. Further, to date, individualized care, inclusive of personalized medicine and patient- and person-centered care have been marginally incorporated in the field's understanding of OSA and PAP adherence. This integrative review describes current PAP adherence assessment processes, interventions to improve adherence, and outlines future opportunities to advance the field, particularly as it relates to individualizing care and the use of implementation science to apply evidence to practice.
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Affiliation(s)
- Alexa J Watach
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Alexa J Watach University of Pennsylvania, School of Nursing, Claire Fagin Hall, Rm 349, 418 Curie Blvd, Philadelphia, PA, 19104, USATel +1-717-599-9908 Email
| | - Dennis Hwang
- Kaiser Permanente Southern California, Sleep Medicine and Department of Research and Evaluation, Fontana, CA, USA
| | - Amy M Sawyer
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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30
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Zarhin D. "You have to do something": Snoring, sleep interembodiment and the emergence of agency. THE BRITISH JOURNAL OF SOCIOLOGY 2020; 71:1000-1015. [PMID: 32633421 DOI: 10.1111/1468-4446.12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/18/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
Although the sociology of sleep is a growing subfield, little is known about agency in the context of sleep. This article contributes to the sociological literature by showing how different types of agency emerge as a result of sleep interembodiment (i.e., experiencing sleep partners' bodies as intertwined). The study draws on qualitative data generated through in-depth interviews with 70 snorers and 20 sleep partners of snorers. Interviews were conducted in Israel and were analysed following constructivist grounded theory principles. Results indicate that two types of agency coexist and, in fact, co-constitute one another: The first type, herein termed material agency, reflects the post-humanist tradition, which conceptualizes agents as entities (whether human or nonhuman) that alter a state of affairs by making a difference in another agent's action. This type of agency exists in both wakefulness and throughout periods of sleep, as the snorer's body acts and interacts with a partner's body in ways that engender significant change in their lives, relationships, and actions. In contrast, the second type, herein termed reflexive agency, reflects the humanist tradition, which regards agency as individuals' creative and assertive capacities motivated by intentionality and reflexivity. This type of agency declines significantly during stages of deep sleep but re-emerges in response to partners' actions. The article adds to the literature by refining the concept of agency and elucidating its relationship to both accountability and interembodiment. In addition, the article provides much-needed empirical evidence showing how "personal responsibility" for health, as required by neoliberal discourses, is invoked within families, specifically with regard to sleep. This study therefore shows how certain macro-level structures of neoliberalism are enacted and reinforced within micro-level interactions.
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Affiliation(s)
- Dana Zarhin
- Department of Sociology, University of Haifa, Haifa, Israel
- Department of Sociology, Brandeis University, Waltham, USA
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31
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Adams GC, Skomro R, Wrath AJ, Le T, McWilliams LA, Fenton ME. The relationship between attachment, treatment compliance and treatment outcomes in patients with obstructive sleep apnea. J Psychosom Res 2020; 137:110196. [PMID: 32726733 DOI: 10.1016/j.jpsychores.2020.110196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 07/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a common condition with numerous health and psychological consequences. While treatment with Continuous Positive Airway Pressure (CPAP) is highly effective, it seems to be impacted by interpersonal aspects of the patient. The current study explores the role of two major interpersonal descriptors (attachment and relationship satisfaction) on treatment initiation and compliance with CPAP. The benefit of CPAP treatment on sleep measures and psychological functioning is also examined. METHODS Participants in stable relationships, diagnosed with OSA following an inpatient polysomnography test (N = 83), were recruited. Participants were appraised on their decision to initiate treatment and completed interpersonal measures (couples' satisfaction, attachment dimensions) as well as sleep measures and mental health measures. Participants were invited to repeat the measures after 3 months (N = 31 agreed). Associations between interpersonal measures and CPAP initiation and compliance as well as the impact of CPAP on sleep and all psychological measures was assessed. RESULTS Individuals with high attachment anxiety pursued OSA treatment based on a mutual decision with the partner, while individuals with lower attachment anxiety made the decision themselves. Couples' satisfaction was positively associated with CPAP compliance over 3 months. CPAP compliance significantly improved sleep measures, mood and anxiety symptoms. CONCLUSION The study brings evidence for a positive role of interpersonal factors in the initiation and compliance with OSA treatment as well as longitudinal benefits on sleep, mood and anxiety levels. The results can inform clinical approaches meant to increase treatment engagement and adherence in OSA patients through psychoeducation.
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Affiliation(s)
- G Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Robert Skomro
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Andrew J Wrath
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Thuy Le
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Lachlan A McWilliams
- Department of Psychology, College of Arts and Science, University of Saskatchewan, Saskatoon, Canada
| | - Mark E Fenton
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Waldman LT, Parthasarathy S, Villa KF, Bron M, Bujanover S, Brod M. Understanding the burden of illness of excessive daytime sleepiness associated with obstructive sleep apnea: a qualitative study. Health Qual Life Outcomes 2020; 18:128. [PMID: 32381095 PMCID: PMC7206792 DOI: 10.1186/s12955-020-01382-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS), which may go undiagnosed and can significantly impair a patient’s health-related quality of life (HRQOL). This qualitative research examined timing and reasons patients sought medical care for their EDS and OSA symptoms, and the impact of EDS on HRQOL. Methods Focus groups were conducted in 3 US cities with 42 participants currently experiencing EDS with OSA. Transcripts were coded and analyzed using an adapted grounded theory approach common to qualitative research. Results Over three-fifths of study participants (n = 26, 62%) were currently using a positive airway pressure (PAP) or dental device; one-third (n = 14, 33%) had previously used a positive airway pressure (PAP) or dental device, and the remainder had either used another treatment (n = 1, 2%) or were treatment naïve (n = 1, 2%). Twenty-two participants (52%) reported experiencing OSA symptoms for ≥1 year, with an average duration of 11.4 (median 8.0, range 1–37) years before seeking medical attention. Several (n = 7, 32%) considered their symptoms to be “normal,” rather than signaling a serious medical condition. Thirty participants (71%) discussed their reasons for ultimately seeking medical attention, which included: input from spouse/partner, another family member, or friend (n = 20, 67%); their own concern about particular symptoms (n = 7, 23%); and/or falling asleep while driving (n = 5, 17%). For all 42 participants, HRQOL domains impacted by EDS included: physical health and functioning (n = 40, 95%); work productivity (n = 38, 90%); daily life functioning (n = 39, 93%); cognition (n = 38, 90%); social life/relationships (n = 37, 88%); and emotions (n = 30, 71%). Conclusions Findings suggest that patients may be unaware that their symptoms could indicate OSA requiring evaluation and treatment. Even following diagnosis, EDS associated with OSA can continue to substantially affect HRQOL and daily functioning. Further research is needed to address diagnostic delays and unmet treatment needs for patients with EDS associated with OSA.
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Affiliation(s)
| | - Sairam Parthasarathy
- University of Arizona Health Sciences Center for Sleep and Circadian Sciences and Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona, Tucson, AZ, USA
| | | | | | | | - Meryl Brod
- The Brod Group, 219 Julia Ave, Mill Valley, CA, 94941, USA
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Abstract
Obstructive sleep apnea (OSA) syndrome is a destructive and insidious entity mostly underdiagnosed and undertreated. It affects not only individuals but the society as a whole. The costs to the populations can be measured not only in morbidity and mortality but also in the financial wellbeing of a society. Financial burden of this disease is staggering. The social fabric of society is also greatly impacted. Physiologic effects of OSA are far reaching. It has been shown that early intervention with treatment of OSA can often prevent and/or reverse many of the negative outcomes associated with this condition.
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Khan NNS, Olomu AB, Bottu S, Roller MR, Smith RC. Semistructured Motivational Interviews of Patients and Caregivers to Improve CPAP Adherence: A Qualitative Analysis. J Clin Sleep Med 2019; 15:1721-1730. [PMID: 31855157 PMCID: PMC7099183 DOI: 10.5664/jcsm.8070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVES The aim of this qualitative analysis was to identify obstructive sleep apnea (OSA) patients' preferences, partner experiences, barriers and facilitators to positive airway pressure (PAP) adherence, and to assess understanding of the educational content delivered and satisfaction with the multidimensionally structured intervention. METHODS A qualitative analysis was conducted on 28 interventional arm patients with a new diagnosis of OSA. They received a one-on-two semistructured motivational interview as the last part of a 60- to 90-minute in-person educational group intervention. The 10- to 15-minute interview with the patient and caregiver was patient-centered and focused on obtaining the personal and emotional history and providing support. We also assessed understanding of the OSA training plan, their commitment to it, and their goals for it. RESULTS We identified four themes: OSA symptom and diagnosis, using the PAP machine, perceptions about the group visit, and factors that determine adherence to PAP. Patients experienced positive, negative, or mixed emotions during the journey from symptoms of OSA to PAP adherence. CONCLUSIONS Our findings suggest that patients' and caregivers' positive experiences of PAP could be enhanced by a patient-centered interaction and that it was important to explicitly address their fears and concerns to further enhance use of PAP. Not only could caregiver support play a role in improving PAP adherence but also the peer coaching session has the potential of providing a socially supportive environment in motivating adherence to PAP treatment.
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Affiliation(s)
- Nazia Naz S. Khan
- Department of Medicine, Michigan State University, College of Human Medicine, East Lansing, Michigan
| | - Adesuwa B. Olomu
- Department of Medicine, Michigan State University, College of Human Medicine, East Lansing, Michigan
| | - Shireesha Bottu
- Department of Medicine, Michigan State University, College of Human Medicine, East Lansing, Michigan
| | - Margaret R. Roller
- Michigan State University Office for Survey Research, East Lansing, Michigan
| | - Robert C. Smith
- Department of Medicine, Michigan State University, College of Human Medicine, East Lansing, Michigan
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Lo Bue A, Salvaggio A, Iacono Isidoro S, Romano S, Insalaco G. OSA and CPAP therapy: effect of gender, somnolence, and treatment adherence on health-related quality of life. Sleep Breath 2019; 24:533-540. [PMID: 31309464 DOI: 10.1007/s11325-019-01895-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) often has a significant impact on health-related quality of life (HRQoL) with social and psychological implications. For most OSA patients, a reduction in their HRQoL is due to symptoms such as poor sleep quality, excessive daytime somnolence, and fatigue with differences between gender. PURPOSE This study explores the CPAP treatment effect on self-perceived HRQoL related to gender, somnolence, and CPAP adherence. METHODS Out of 1082 consecutive Italian outpatients, 125 (82 M) (60.3 ± 9.6 years) completed the prospective observational study and were evaluated at the first visit (T0), and the follow-up visit (T1). Two self-reported HRQoL questionnaires were administered: six subscales Psychological General Well-Being Index (PGWBI) and 12-Item Short-Form Health Survey (SF-12). RESULTS Scores of PGWBI and SF-12 MCS improved from T0 to T1. Patients with CPAP use ≥ 4 h/night showed a significant improvement in all dimensions evaluated, except for SF-12 PCS. At T1, participants with ESS > 10 improved in all scores, except SF-12 PCS. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up visit. Variation of PGWBI was significantly correlated with CPAP use, ESS at T0 and T1 (p < 0.0001; r2 = 0.26). CONCLUSIONS This study provides evidence on the effectiveness of CPAP treatment on perceived HRQoL. Participants with greater adherence to therapy, greater sleepiness, and greater improvement of daytime sleepiness with CPAP therapy, reported a higher quality of life improvement. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up, despite a more considerable improvement in females.
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Affiliation(s)
- Anna Lo Bue
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Adriana Salvaggio
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy.
| | - Serena Iacono Isidoro
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Salvatore Romano
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Giuseppe Insalaco
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
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Møkleby M, Mengshoel AM. Devoted or negotiated routes of adherence: Narratives of patients with obstructive sleep apnoea using a continuous positive airway pressure device. Nurs Open 2019; 6:1237-1244. [PMID: 31367450 PMCID: PMC6650655 DOI: 10.1002/nop2.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/09/2019] [Accepted: 05/29/2019] [Indexed: 01/10/2023] Open
Abstract
AIMS To explore the narratives of patients about receiving a diagnosis of obstructive sleep apnoea and using a continuous positive airway pressure device. DESIGN A qualitative design with a narrative approach. METHODS Participants with personal experience of using a continuous positive airway pressure device were recruited through purposive sampling. Two women and five men were interviewed in 2017. The data material was subjected to a narrative analysis. RESULTS Two storylines portraying two different trajectories of continuous positive airway pressure use were identified: "A route of devotion" reflects patients experiencing immediate health benefits, which lead to committed use. "A route of negotiations" is characterized by more irregular use, and the perceived benefits were less evident than for those displaying a devoted route. Individuals adjust to a continuous positive airway pressure device differently based on their prior and present life situation and whether use of the device is experienced as an opportunity to regain ordinary life or as an obstacle to maintaining ordinary life.
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Affiliation(s)
- Margareta Møkleby
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
- Pediatric and Adult Sleep Disorder Clinic, ENT DepartmentLovisenberg Diaconal HospitalOsloNorway
| | - Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
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Morsy NE, Farrag NS, Zaki NFW, Badawy AY, Abdelhafez SA, El-Gilany AH, El Shafey MM, Pandi-Perumal SR, Spence DW, BaHammam AS. Obstructive sleep apnea: personal, societal, public health, and legal implications. REVIEWS ON ENVIRONMENTAL HEALTH 2019; 34:153-169. [PMID: 31085749 DOI: 10.1515/reveh-2018-0068] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
Introduction Obstructive sleep apnea (OSA) is a widely prevalent sleep-related breathing disorder, which leads to several life-threatening diseases. OSA has systemic effects on various organ systems. Untreated OSA is associated with long-term health consequences including hypertension, heart disease, diabetes, depression, metabolic disorders, and stroke. In addition, untreated OSA is reported to be associated with cognitive dysfunction, impaired productivity at the workplace and in an increased risk of motor vehicle accidents (MVAs) resulting in injury and fatality. Other consequences of OSA include, but are not limited to, impaired vigilance, daytime somnolence, performance deficits, morning headaches, mood disturbances, neurobehavioral impairments, and general malaise. Additionally, OSA has become an economic burden on most health systems all over the world. Many driving license regulations have been developed to reduce MVAs among OSA patients. Methods Studies of the personal, societal, public health, and legal aspects of OSA are reviewed. Data were collected through the following databases: MEDLINE, Google Scholar, Scopus, SAGE Research Methods, and ScienceDirect. Conclusion OSA leads to worsening of patients' personal relationships, decreasing work productivity, and increasing occupational accidents as well as MVAs. The costs of undiagnosed and untreated OSA to healthcare organizations are excessive. Thus, proper management of OSA will benefit not only the patient but will also provide widespread benefits to the society as a whole.
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Affiliation(s)
- Nesreen E Morsy
- Department of Pulmonary Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Mansoura University Sleep Center, Mansoura, Egypt
| | - Nesrine S Farrag
- Public Health and Preventive Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nevin F W Zaki
- Assistant Professor of Psychiatry, Department of Psychiatry, Faculty of Medicine, Mansoura University, P.O. Box 36551, Gomhoria Street, Mansoura 35511, Egypt
- Mansoura University Sleep Center, Mansoura, Egypt, E-mail:
| | - Ahmad Y Badawy
- Department of Pulmonary Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sayed A Abdelhafez
- Department of Pulmonary Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abdel-Hady El-Gilany
- Public Health and Preventive Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | | | - Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Strategic Technologies Program of the National Plan for Sciences, Technology, and Innovation, Riyadh, Saudi Arabia
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Partner-assisted cognitive behavioural therapy for insomnia versus cognitive behavioural therapy for insomnia: a randomised controlled trial. Trials 2019; 20:262. [PMID: 31068225 PMCID: PMC6506966 DOI: 10.1186/s13063-019-3334-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/28/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Insomnia is a prevalent sleep disorder associated with significant economic and personal burdens. Cognitive behavioural therapy for insomnia (CBTI) is considered the gold standard intervention for insomnia and its efficacy has been well demonstrated. However, the core treatment strategies of CBTI require significant behavioural change, which many individuals find challenging. As a result, although CBTI is efficacious, its effectiveness is reduced by modest levels of adherence in typical clinical settings. This is problematic as adherence is essential to attain desired treatment outcomes. Sleep is often a dyadic process, with approximately 60% of Australian adults sharing a bed. Hence, the present study aims to determine whether incorporating bed partners into treatment for insomnia increases treatment adherence and completion. The impact of adherence on symptoms of insomnia will also be examined. METHODS This study is a mixed-effects randomised effectiveness trial of partner-assisted CBTI (PA-CBTI). It is an "effectiveness" (as opposed to "efficacy") trial, due to the focus on "real world" clinic-based clients and adherence/attrition as outcomes. Participants will include 120 clients with insomnia who are randomly assigned, in equal numbers, to PA-CBTI, traditional individual CBTI (i-CBTI), or partner-assisted sleep management therapy (PA-SMT; which serves as the control group). All interventions consist of seven weekly 1-h sessions. Treatment outcome is evaluated using clinician-rated treatment adherence, and diary-based adherence to stimulus control and sleep restriction. Clients and partners complete major assessments at pre- and post-treatment, and at 6-month follow-up. Secondary outcome variables include actigraphy, self-report measures related to sleep, comorbid psychopathology, and relationship functioning. DISCUSSION This is the first randomised clinical trial to examine the impact of incorporating the bed partner in the treatment of insomnia. Results will provide new information about the role partners play in clients' insomnia presentation and treatment response, and better define the role of adherence in CBTI. This trial has the potential to optimise treatment outcomes for insomnia by improving adherence and reducing attrition. Results could have far-reaching impacts. Improvements in insomnia have been linked to improvements in mental and physical health and, given the high financial costs of insomnia, this study could have a positive economic impact. TRIAL REGISTRATION ACTRN, ACTRN12616000586415 . Registered on 5 May 2016.
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Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go. J Clin Med 2019; 8:jcm8040555. [PMID: 31022916 PMCID: PMC6518292 DOI: 10.3390/jcm8040555] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022] Open
Abstract
The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.
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Luyster FS, Aloia MS, Buysse DJ, Dunbar-Jacob J, Martire LM, Sereika SM, Strollo PJ. A Couples-Oriented Intervention for Positive Airway Pressure Therapy Adherence: A Pilot Study of Obstructive Sleep Apnea Patients and Their Partners. Behav Sleep Med 2019; 17:561-572. [PMID: 29388827 PMCID: PMC6261795 DOI: 10.1080/15402002.2018.1425871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Partner involvement can influence positive airway pressure (PAP) therapy use among patients with obstructive sleep apnea (OSA). This study assessed the feasibility, acceptability, and preliminary efficacy of a couples-oriented education and support (CES) intervention for PAP adherence. Participants: Thirty newly diagnosed OSA patients and their partners were randomly assigned to one of three groups: an education and support intervention directed at both patient and partner (CES), an education and support intervention directed only at the patient (PES), or usual care (UC). Methods: Feasibility and acceptability were assessed through enrollment and posttreatment program evaluations, respectively. Assessments of sleep quality, daytime sleepiness, and daytime function were obtained from both patients and partners at baseline and 3 months after PAP initiation. Objective PAP adherence was assessed at 1 week, 1 month, and 3 months. Results: Recruitment and attrition data suggest adequate feasibility. All patients and partners in the CES group reported that the intervention was helpful. Patients in the CES and PES groups increased their PAP adherence over the first month of treatment, whereas PAP adherence decreased over this period in the UC group. For patients, large to medium effects for sleep quality (d = -1.01), daytime sleepiness (d = -0.51), and daytime function (d = 0.51) were found for the CES group. The PES and UC groups effect sizes were large to small for sleep quality (d = -0.94; d = -0.40), daytime sleepiness (d = -0.42; d = -0.82), and daytime function (d = 0.41; d = 0.57), respectively. For partners, large effects for daytime sleepiness (d = -1.31) and daytime function (d = 1.54) and small to medium effect for sleep quality (d = -0.31) were found for the CES group. Worsening of sleep quality (d = 0.65) and no change in daytime sleepiness or daytime function were found for the PES group. For the UC group, medium to large effects were found for sleep quality (d = -0.77), daytime sleepiness (d = -0.77), and daytime function (d = 0.65). Conclusions: The findings of this pilot study provide support for taking a couples intervention approach to improve PAP adherence.
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Affiliation(s)
- Faith S. Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark S. Aloia
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Daniel J. Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Lynn M. Martire
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania
| | - Susan M. Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J. Strollo
- Divison of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania;,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Gentina T, Bailly S, Jounieaux F, Verkindre C, Broussier PM, Guffroy D, Prigent A, Gres JJ, Kabbani J, Kedziora L, Tamisier R, Gentina E, Pépin JL. Marital quality, partner's engagement and continuous positive airway pressure adherence in obstructive sleep apnea. Sleep Med 2018; 55:56-61. [PMID: 30771736 DOI: 10.1016/j.sleep.2018.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/23/2018] [Accepted: 12/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the first line therapy for obstructive sleep apnea (OSA) but its effectiveness requires high adherence. We aimed to assess the impacts of the spouse's/partner's involvement and the quality of the couple's relationship on CPAP adherence. METHODS In a multicenter prospective study conducted in France, patients reported their subjective views regarding their partner's engagement in their CPAP treatment and the quality of their marital relationship using the Quality of Marriage Index. A hierarchical linear model was built to assess the predictors of CPAP adherence at day 120. Structural equation modeling was performed to evaluate the direct and indirect effects of the spouse's/partner's engagement and the quality of the couple's relationship on CPAP adherence. RESULTS The 290 OSA patients were predominantly male (77%), with a median age of 53 years IQR: [46; 62], median BMI: 32 kg/m2 [28.6; 35.9] and median apnea + hypopnea index: 43/per hour [33; 58]. Independent factors for CPAP adherence at day 120 were the partner's encouragement of CPAP usage and a stable relationship exceeding 30 years, although emotional support or collaboration were not associated with CPAP adherence. Structural equation modeling demonstrated that spouse's/partner's engagement is directly related to CPAP adherence and improvement of symptoms, and that CPAP adherence is a mediator of disease-specific health-related quality of life. Marital quality was a significant moderator of these interactions meaning that a spouse's/partner's engagement improved adherence only when the quality of marriage index was high. CONCLUSION Future research and integrated OSA management should systematically include and document the role of the spouse/partner in CPAP adherence.
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Affiliation(s)
- Thibaut Gentina
- Ramsey General Healthcare La Louviere Hospital, Lille, France.
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | | | | | | | | | | | | | | | | | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | - Elodie Gentina
- IESEG School of Management, LEM-CNRS (UMR 9221), Lille, France.
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
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Graco M, Green SE, Tolson J, Stevens B, Barnes M, Rigoni A, Henderson S, Nicholls C, Berlowitz DJ. Worth the effort? Weighing up the benefit and burden of continuous positive airway pressure therapy for the treatment of obstructive sleep apnoea in chronic tetraplegia. Spinal Cord 2018; 57:247-254. [PMID: 30356181 DOI: 10.1038/s41393-018-0210-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/22/2018] [Accepted: 10/04/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Mixed methods OBJECTIVES: Continuous positive airway pressure (CPAP) therapy is the recommended treatment for obstructive sleep apnoea (OSA). The aim of this study was to estimate CPAP adherence in people with tetraplegia and OSA, and to explore the barriers and facilitators to CPAP use. SETTING Hospital outpatient department in Melbourne, Australia METHODS: People with chronic tetraplegia and OSA were commenced with auto-titrating CPAP and supported for 1 month. Semi-structured interviews were conducted with participants at one month and analysed thematically. CPAP usage was measured at 1, 6 and 12 months, with "adherent" defined as achieving more than 4 h average per night. RESULTS Sixteen participants completed the study (80% male; mean age 56 (SD = 15)). Mean nightly CPAP use at one month was 3.1 h (SD = 2.5; 38% adherent), and at 6 months and 12 months were 2.6 h (SD = 2.8; 25% adherent) and 2.1 h (SD = 3.2; 25% adherent). The perceived benefit/burden balance strongly influenced ongoing use. Burden attributed to CPAP use was common, and included mask discomfort, and physical and emotional problems. Adherent participants were motivated by the immediate daytime benefits to mood, alertness and sleepiness. There was a tendency to not recognise symptoms of OSA until after they were treated. CONCLUSION CPAP use is challenging for people with tetraplegia, who experience substantial burden from using the device. When tolerated, the proximate benefits are substantial. People with tetraplegia need more intensive support for longer to help them overcome the burdens of CPAP and benefit from the treatment.
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia. .,The University of Melbourne, Department of Medicine, Melbourne, Victoria, Australia.
| | - Sally E Green
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Julie Tolson
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Bronwyn Stevens
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Department of Medicine, Melbourne, Victoria, Australia
| | - Alyssa Rigoni
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Sandra Henderson
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Carmel Nicholls
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Department of Physiotherapy, Melbourne, Victoria, Australia
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Timkova V, Nagyova I, Reijneveld SA, Tkacova R, van Dijk JP, Bültmann U. Social support, mastery, sleep-related problems and their association with functional status in untreated obstructive sleep apnoea patients. Heart Lung 2018; 47:371-379. [PMID: 29778252 DOI: 10.1016/j.hrtlng.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/18/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Social support and mastery are important aspects in the treatment of chronic diseases, however their role in connection with Obstructive Sleep Apnoea (OSA) remains unclear. OBJECTIVES The study examined the associations between social support, mastery, sleep-related problems and functional status in untreated OSA patients. METHODS All patients in this cross-sectional study completed the Multidimensional Scale of Perceived Social Support, the Pearlin Mastery Scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire. Multiple linear regression and mediation analyses were used to analyse the data. RESULTS Participants were 150 newly diagnosed OSA patients (Apnoea-Hypopnoea Index-AHI≥5; 68% male; mean age 48.9 ± 9.5years). Compared with social support, mastery was more strongly associated with functional status. The indirect effects of sleep-related problems on functional status via mastery varied between 17.7% and 23.3%. CONCLUSIONS Supporting OSA patients' sense of mastery may significantly contribute to better disease management.
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Affiliation(s)
- Vladimira Timkova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia; Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Slovakia.
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Sijmen A Reijneveld
- University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, The Netherlands
| | - Ruzena Tkacova
- Department of Pneumology and Phtiseology, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Slovakia; University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, The Netherlands
| | - Ute Bültmann
- University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, The Netherlands
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Timkova V, Nagyova I, Reijneveld SA, Tkacova R, Stewart RE, van Dijk JP, Bültmann U. Suicidal ideation in patients with obstructive sleep apnoea and its relationship with disease severity, sleep-related problems and social support. J Health Psychol 2018; 25:1450-1461. [PMID: 29493290 DOI: 10.1177/1359105318758859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We aimed to assess the prevalence of suicidal ideation and to examine the relationships between obstructive sleep apnoea severity, sleep-related problems, social support and suicidal ideation in obstructive sleep apnoea patients. We included 149 patients (68% male; mean age, 48.99 ± 9.57 years) with diagnosed obstructive sleep apnoea (Apnoea–Hypopnoea Index ⩾5) based on full-night polysomnography. The prevalence of suicidal ideation among obstructive sleep apnoea patients was 20.1 per cent. Structural equation modelling showed that suicidal ideation in obstructive sleep apnoea was strongly related to poor sleep quality and high fatigue levels. No relationship between social support and suicidal ideation in obstructive sleep apnoea patients was found.
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Affiliation(s)
- Vladimira Timkova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ruzena Tkacova
- Department of Pneumology and Phtiseology, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Roy E Stewart
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Kosice, Slovakia
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Gibson R, Campbell A, Mather S, Neill A. From diagnosis to long-term management: the experiences of older New Zealanders with obstructive sleep apnoea. J Prim Health Care 2018; 10:140-149. [DOI: 10.1071/hc17072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
ABSTRACT INTRODUCTION In New Zealand (NZ), access to public sleep services is limited to people deemed with the highest need. The prevalence of obstructive sleep apnoea (OSA) increases with age, but the symptoms and the treatment pathway is expected to differ for older compared to younger patients. This study explored the experience of older people regarding diagnosis and treatment services for OSA in order to inform considerations required in primary health and sleep services. METHODS Patients who were initiated on Continuous Positive Airway Pressure (CPAP) therapy at the age of 65 years or older were invited to one of three 1.5-h focus group discussions. In total, 16 patients attended; nine were accompanied by their spouse or partner. Discussions were semi-structured and explored experiences with the OSA pathway, from diagnosis through to long-term management. RESULTS Thematic analysis highlights the key symptoms of OSA. Patients’ experiences with diagnostic and treatment services were generally positive. However, there was an overarching need for greater knowledge and follow up regarding OSA and CPAP therapy. Most patients were happy with CPAP treatment. Issues associated with long-term use, comfort and daily management were highlighted, and strategies used to overcome them discussed. DISCUSSION Focus groups reported similar experiences, positively endorsing the health value of OSA diagnosis and CPAP therapy. Mechanisms and resources are required at a primary healthcare level in order to raise awareness around sleep and aging, OSA and CPAP. This would aid earlier and more appropriate diagnosis and management of OSA and help overcome some of the gaps identified in this study.
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Ye L, Antonelli MT, Willis DG, Kayser K, Malhotra A, Patel SR. Couples' experiences with continuous positive airway pressure treatment: a dyadic perspective. Sleep Health 2017; 3:362-367. [PMID: 28923193 DOI: 10.1016/j.sleh.2017.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/03/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The majority of adults sleep with a partner, making sleep a dyadic experience. However, interventions to improve sleep have primarily focused on individuals. This qualitative analysis used a dyadic approach to identify facilitators and barriers to successful treatment of one of the most common sleep disorders, obstructive sleep apnea, with continuous positive airway pressure (CPAP). METHODS Twenty joint qualitative interviews were conducted with couples, one couple at a time, with a sample of 20 patients with obstructive sleep apnea and their partners to develop an understanding of couples' experiences with CPAP use. Interviews were audio recorded and transcribed. Conventional qualitative content analysis was used to analyze the interview data. RESULTS Facilitators of CPAP use were the following: the partner aiding diagnosis and treatment, couples working together using CPAP, the perceived benefits of CPAP for both partners, the patient being motivated to use CPAP for the benefit of the partner, and various types of support provided by the partner to encourage CPAP use. Major barriers to CPAP use were the following: anxiety related to CPAP use particularly in the beginning of therapy, bothersome equipment causing disruptions in sleep and bedtime routine, interruptions to intimacy, and concern about image change while wearing CPAP. CONCLUSIONS Findings from this study suggest that couple-directed interventions that advocate for a mutually engaging perspective and promote supportive relationships and positive dyadic coping may be targets for improving CPAP adherence. Further research evaluating the potential of couple-focused interventions to improve sleep health is warranted.
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Affiliation(s)
- Lichuan Ye
- Bouvé College of Health Sciences School of Nursing, Northeastern University, Boston, MA, USA.
| | - Mary T Antonelli
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Danny G Willis
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Karen Kayser
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care & Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sanjay R Patel
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Luyster FS. Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review. J Clin Sleep Med 2017; 13:467-477. [PMID: 28095973 DOI: 10.5664/jcsm.6504] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVES Many adults sleep with a significant other; thus, sleep disorder symptoms and treatments of one partner are likely to impact the other partner's health. A literature review was conducted to examine the impact of obstructive sleep apnea (OSA) and OSA treatments on partner-assessed sleep and daytime functioning and partner involvement in OSA treatment. METHODS MEDLINE, EMBASE, and CINAHL searches yielded 38 pertinent quantitative and qualitative studies that described sleep and/or daytime functioning assessed in partners of patients with untreated OSA, sleep and/or daytime functioning assessed in partners who were referred for OSA treatment, including continuous positive airway pressure (CPAP) therapy, oral appliance (OA), or surgery, and/or associations between partner involvement and OSA treatment use. RESULTS The majority of studies found untreated OSA to have a negative impact on partners' objective and subjective sleep and daytime functioning, in particular mood, quality of life, and relationship quality. Improvements in partner-assessed sleep quality were reported for CPAP, OA, and surgery. Conflicting results were reported for partners' mood, quality of life, daytime sleepiness, and relationship quality. Perceived partner support was associated with greater CPAP use. CONCLUSIONS Symptoms associated with OSA can negatively impact partners' sleep and daytime functioning. Treatment of OSA with CPAP, OA, or surgery can have health benefits for not only patients but also partners. Collaborative partner involvement may be a useful strategy for interventions promoting CPAP adherence.
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