1
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Burcea R, Mihaltan FD. Predictive factors of adherence in Patients with Obstructive Sleep Apnea Syndrome to Continuous Positive Airway Pressure Therapy in Romania. MAEDICA 2023; 18:278-285. [PMID: 37588845 PMCID: PMC10427109 DOI: 10.26574/maedica.2023.18.2.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Introduction: Obstructive sleep apnea syndrome (OSAS) is a very frequent and underdiagnosed pathology with important social and economic implications. Continuous positive airway pressure (CPAP) is the gold standard for the treatment of OSAS, but adherence is low, with multiple factors being involved in this phenomenon. The purpose of the current study is to evaluate the causes of low adherence to CPAP among adults with OSAS and patients' symptoms. Materials and methods: We performed a prospective cohort study which included 95 patients admitted to Rosiori de Vede Pneumology Hospital, who were diagnosed with OSAS between January 2021-January 2023 and had indication to receive CPAP. Patients were divided into two groups (adherents and non-adherents) and were evaluated for one year based on completing a questionnaire and downloading data from the compliance card of CPAP on their regular visits at one month, six months and 12 months after diagnosis. Results:The predictive factors identified for non-adherence included oro-nasal mask use, low OSAS severity, low level of education, type D personality, high level of daytime sleepiness, and the first period of time with CPAP. Conclusion:Obstructive sleep apnea syndrome is a frequent and underdiagnosed pathology which benefits from CPAP as the gold standard treatment option. Although therapeutic results are favourable and effects are rapidly observed in symptomatic moderate-severe OSA, adherence to therapy remains low.
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Affiliation(s)
- Romica Burcea
- Rosiori de Vede Pneumology Hospital, Romania
- "Marius Nasta" Pneumology Institute Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | - Florin Dumitru Mihaltan
- "Marius Nasta" Pneumology Institute Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
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2
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Khan M, Stone A, Soose RJ, Cohen SM, Howard J, Capasso R, Itayem D, Gillespie MB, Mehra R, Chio E, Strollo PJ, Menzl A, Kaplan A, Ni Q. Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea? J Clin Sleep Med 2022; 18:2167-2172. [PMID: 35681251 PMCID: PMC9435342 DOI: 10.5664/jcsm.10068] [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: 11/30/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Untreated obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, decreased quality of life, and cardiovascular disease. Positive airway pressure is the first-line therapy for OSA; however, adherence is difficult. Upper airway stimulation is a Food and Drug Administration-approved treatment of OSA. The objective of this study was to evaluate for a difference in treatment efficacy and adherence of upper airway stimulation therapy for OSA between individuals who are White and non-White using data from the ADHERE registry. METHODS ADHERE registry is a multicenter prospective study of real-world experience of upper airway stimulation for treatment of OSA in the United States and Europe. Propensity score matching was used to create a balanced dataset between the White and non-White groups. t-Tests at a significance level of 5% were used to compare numeric values between groups. RESULTS There were 2,755 participants of the ADHERE registry: 27 were excluded due to not having a race identified, 125 participants identified as non-White, 2,603 identify as White, and 27 did not provide race information. Propensity score matching was used to select 110 participants, with 55 White and 55 non-White for the noninferiority analysis. We did not find a difference in adherence, treatment apnea-hypopnea index, changes in Epworth Sleepiness Scale score, or clinical global impression after intervention score between White and non-White individuals. CONCLUSIONS Our study found that there was no statistically significant difference in adherence or efficacy with upper airway stimulation therapy between White and non-White individuals. However, the percent of non-White people implanted is low, which suggests a need to expand access to this therapy for non-White populations with OSA who cannot tolerate positive airway pressure therapy. CITATION Khan M, Stone A, Soose RJ, et al. Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea? J Clin Sleep Med. 2022;18(9):2167-2172.
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Affiliation(s)
- Meena Khan
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andre Stone
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ryan J Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samuel M Cohen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Javier Howard
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Deeyar Itayem
- Department of Otolaryngology Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - M Boyd Gillespie
- Department of Otolaryngology Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Reena Mehra
- Sleep Disorders Center, Neurologic Institute, Respiratory Institute, Heart and Vascular Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene Chio
- Department of Otolaryngology Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine and Veterans Administration Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Anna Menzl
- Inspire Medical Systems, Golden Valley, Minnesota
| | - Adam Kaplan
- Inspire Medical Systems, Golden Valley, Minnesota
| | - Quan Ni
- Inspire Medical Systems, Golden Valley, Minnesota
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3
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Goldstein LA, Purcell N, Sarmiento KF, Neylan TC, Maguen S. Barriers to positive airway pressure adherence among veterans with sleep apnea: a mixed methods study. Transl Behav Med 2022; 12:870-877. [PMID: 35640475 DOI: 10.1093/tbm/ibac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rates of adherence to positive airway pressure (PAP) for sleep apnea are suboptimal. Though previous studies have identified individual factors associated with PAP nonadherence, few projects have investigated a wide range of possible barriers directly from the patient perspective. We examined the range of factors that patients identify as barriers to optimal use of PAP as well as the solutions most commonly offered by providers. We employed a mixed methods design including semistructured interviews and medical record review at a US Department of Veterans Affairs Medical Center. Thirty patients identified as nonadherent to PAP participated. Patients were asked to report on current sleep problems, reasons for nonadherence, and solutions proposed by providers. Chart review was used to identify untreated apnea severity, Epworth Sleepiness Scale score, therapy hours, and residual apnea severity. Patients described physical and psychological barriers to adherent use at approximately equal rates: Mask leaks and dry throat/nose were common physical barriers, and anxiety/claustrophobia and worsening insomnia were common psychological barriers. Untreated apnea severity, residual apnea severity, and daytime sleepiness were not associated with therapy hours. Solutions offered by providers most frequently addressed physical barriers, and solutions to psychological barriers were rarely proposed. The most common solution offered by providers was trying different masks. We recommend individualized assessment of each patient's barriers to use as well as increased involvement of behavioral health providers in sleep medicine clinics.
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Affiliation(s)
- Lizabeth A Goldstein
- San Francisco Veterans Affairs Health Care System, Mental Health Service, San Francisco, CA, USA.,San Francisco Veterans Affairs Health Care System, Research Service, San Francisco, CA, USA.,University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | - Natalie Purcell
- San Francisco Veterans Affairs Health Care System, Integrative Health Service, San Francisco, CA, USA.,University of California, San Francisco, Department of Social and Behavioral Sciences, San Francisco, CA, USA
| | - Kathleen F Sarmiento
- San Francisco Veterans Affairs Health Care System, Medical Service, San Francisco, CA, USA.,University of California, San Francisco, Department of Medicine, San Francisco, CA, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, Mental Health Service, San Francisco, CA, USA.,University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, Mental Health Service, San Francisco, CA, USA.,University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
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Cohen SM, Howard JJ, Jin MC, Qian J, Capasso R. Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea. OTO Open 2022; 6:2473974X221088870. [PMID: 35321423 PMCID: PMC8935572 DOI: 10.1177/2473974x221088870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Determine risk factors for failure to receive surgical treatment among patients with obstructive sleep apnea. Study Design Population-based observational longitudinal cohort study. Setting Population-based database. Methods Multivariate analysis of 500,792 individuals with obstructive sleep apnea from Optum’s deidentified Clinformatics Data Mart database (2004-2018). Results Black race, increased age, diabetes, atrial fibrillation, obesity, and congestive heart failure were independently associated with a decreased rate of surgery for obstructive sleep apnea. Asian race, hypertension, arrhythmias other than atrial fibrillation, pulmonary disease, and liver disease were independently associated with an increased rate of surgery for obstructive sleep apnea. Conclusion Racial disparities in health outcomes related to health care access and in economic resources have an enormous impact on public health and social equity. We found differences in rates of surgery for obstructive sleep apnea based on race. These data are consistent with others demonstrating disparities in medical treatment of sleep apnea with positive pressure and underline a need for a change in awareness and treatment in these populations.
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Affiliation(s)
- Samuel M. Cohen
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Javier J.M. Howard
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Michael C. Jin
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Jason Qian
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Robson Capasso
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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5
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Lee YC, Chang KY, Mador MJ. Racial Disparity in Sleep Apnea-Related Mortality in the United States. Sleep Med 2022; 90:204-213. [DOI: 10.1016/j.sleep.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/22/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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Narang I, Kendzerska T, Heffernan A, Malik U, Carvalho CG, Ryan CM. Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care. Nat Sci Sleep 2022; 14:153-163. [PMID: 35140537 PMCID: PMC8818969 DOI: 10.2147/nss.s345143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses. RESEARCH QUESTION Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA? STUDY DESIGN AND METHODS Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders. RESULTS Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17-18), median BMI was 30.3 (IQR: 24.0-37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8-30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3-8.0) vs 2.6 hours/day (0.0-6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of -1.14; 95% CI -2.27 to -0.01. INTERPRETATION Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.
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Affiliation(s)
- Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Canada.,Sleep Research laboratory, KITE-UHN
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7
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Borriboon C, Chaiard J, Tachaudomdach C, Turale S. Continuous positive airway pressure adherence in people with obstructive sleep apnoea. J Clin Nurs 2021; 31:3477-3484. [PMID: 34962327 DOI: 10.1111/jocn.16174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/07/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This cross-sectional study aimed to identify whether five factors of the health belief model were related to continuous positive airway pressure adherence in Thai people with obstructive sleep apnoea. BACKGROUND Obstructive sleep apnoea is a disorder impacting health, social wellbeing and the economy. Continuous positive airway pressure is a gold standard of treatment; however, poor adherence to treatment is an important issue that is related to a multiplicity of psychological and behavioural factors. METHODS The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was used to report the study. Purposive sampling was used to recruit 94 patients newly diagnosed with sleep apnoea and using CPAP devices from a sleep clinic. Participants completed a demographic record, the Thai versions of the Functional Outcomes of Sleep Questionnaire, the Perceived Barriers Questionnaire and the Self-Efficacy Measure for Sleep Apnea. CPAP adherence was measured by using information downloaded from the smart card of the devices. Data were analysed using descriptive statistics and logistic regression. RESULTS Only 54.3% of participants adhered to CPAP treatment using standard protocols. Perceived seriousness of their condition was significantly associated with CPAP adherence, whereas perceived susceptibility, benefits, barriers and self-efficacy were not. CONCLUSIONS We found a low rate of CPAP adherence among participants. The only factor related to CPAP adherence was perceived seriousness. RELEVANCE FOR THE CLINICAL PRACTICE With a low rate of CPAP adherence, healthcare professionals, especially nurses, should encourage patients to use CPAP regularly by providing them with support and education regarding the severity of the disease if untreated and the benefits of CPAP treatment on the disease. Healthcare professionals should be aware of psychological factors impacting patients' perception of sleep apnoea and CPAP treatment. Interventions dealing with these factors should be developed and implemented in practice.
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Affiliation(s)
| | | | | | - Sue Turale
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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8
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Borker PV, Carmona E, Essien UR, Saeed GJ, Nouraie SM, Bakker JP, Stitt CJ, Aloia MS, Patel SR. Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence. Am J Respir Crit Care Med 2021; 204:339-346. [PMID: 33689593 DOI: 10.1164/rccm.202009-3685oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Limited data suggest racial disparities in continuous positive airway pressure (CPAP) adherence exist.Objectives: To assess whether CPAP adherence varies by neighborhood racial composition at a national scale.Methods: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in adult patients initiating CPAP therapy between November 2015 and October 2018. Mapping ZIP code to ZIP code tabulation areas, age- and sex-adjusted CPAP adherence data at a neighborhood level was computed as a function of neighborhood racial composition. Secondary analyses adjusted for neighborhood education and poverty.Measurements and Main Results: Among 787,236 patients living in 26,180 ZIP code tabulation areas, the prevalence of CPAP adherence was 1.3% (95% confidence interval [CI], 1.0-1.6%) lower in neighborhoods with high (⩾25%) versus low (<1%) percentages of Black residents and 1.2% (95% CI, 0.9-1.5%) lower in neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both), even after adjusting for neighborhood differences in poverty and education. Mean CPAP usage was similar across neighborhoods for the first 2 days, but by 90 days, differences in CPAP usage increased to 22 minutes (95% CI, 18-27 min) between neighborhoods with high versus low percentages of Black residents and 22 minutes (95% CI 17-27 min) between neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both).Conclusions: CPAP adherence is lower in neighborhoods with greater proportions of Black and Hispanic residents, independent of education or poverty. These differences lead to a lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.
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Affiliation(s)
- Priya V Borker
- Center for Sleep and Cardiovascular Outcomes Research.,Division of Pulmonary Allergy and Critical Care Medicine
| | - Emely Carmona
- Center for Sleep and Cardiovascular Outcomes Research
| | - Utibe R Essien
- Center for Health Equity and Promotion, and.,Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | | | | | | | | | | | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research.,Division of Pulmonary Allergy and Critical Care Medicine
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9
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Negash A, Khan MA, Medhin G, Wondimagegn D, Pain C, Araya M. Feasibility and acceptability of brief individual interpersonal psychotherapy among university students with mental distress in Ethiopia. BMC Psychol 2021; 9:64. [PMID: 33906688 PMCID: PMC8077191 DOI: 10.1186/s40359-021-00570-1] [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: 02/16/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background The prevalence of mental distress among university students in low- and middle-income countries (LMICs) is increasing; however, the majority do not receive evidence-based psychological intervention.
This calls for the provision of culturally adapted psychological therapy in higher education institutions in LMICs. The aim of this pilot study is to evaluate the feasibility and acceptability of Interpersonal Psychotherapy adapted for Ethiopia (IPT-E) among Wolaita Sodo University students and to assess the preliminary outcomes of IPT-E in reducing symptoms of mental distress and in improving functioning. Methods We used a quasi-experimental single-group pre-post-test study design. As indicators of feasibility of IPT-E, we used consent, treatment completion and attrition. We used Client Satisfaction Questionnaire and semi-structured interview to measure the acceptability of the intervention,
self-reporting IPT-E checklist to assess treatment adherence and World Health Organization Disability Assessment and Self-Reporting Questionnaire-20 tools to assess functional impairment and mental distress, respectively. We used percentage, frequency, mean and standard deviation to summarize the demographic variables, feasibility and acceptability of IPT-E. We analyzed changes from pre- to post-tests of mental distress and functioning results using paired t-test and Wilcoxon signed-rank tests. Independent sample t-test and one way-ANOVA used to assess the difference in mean score of in demographic variables at baseline and eight weeks. The qualitative data was analyzed with the support of open code 4.02. Results IPT-E was feasible (consent rate = 100%; completion rate = 92.31%; attrition rate = 7.69%; mean score of the sessions = 8 and mode of the session = 8). The total mean score of treatment satisfaction was 27.83 (SD = 4.47). After the delivery of IPT-E, symptoms of mental distress were decreased, functioning was improved and therapist adherence to the treatment model was 100% (i.e. treatment delivered according to the IPT-E guideline). Conclusion IPT-E was feasible and acceptable to treat university students with mental distress in low-income country setting. The preliminary results also suggest promising viability of IPT-E in higher education institutions of low-income country setting for students with symptoms of anxiety and depression. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00570-1.
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Affiliation(s)
- Assegid Negash
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Psychology, College of Education and Behavioral Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Matloob Ahmed Khan
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dawit Wondimagegn
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Clare Pain
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Mesfin Araya
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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10
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Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. Sleep Med Clin 2020; 15:227-240. [PMID: 32386697 DOI: 10.1016/j.jsmc.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.
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11
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Sawyer AM, King TS, Weaver TE, Sawyer DA, Varrasse M, Franks J, Watach A, Kolanowski A, Richards KC. A Tailored Intervention for PAP Adherence: The SCIP-PA Trial. Behav Sleep Med 2019; 17:49-69. [PMID: 28128977 PMCID: PMC5529283 DOI: 10.1080/15402002.2016.1276018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE/BACKGROUND Positive airway pressure (PAP) is highly efficacious treatment but nonadherence is prevalent with little improvement over the last 15 years. Tailored interventions show promise for promoting adherence to other treatments. The study objective was to examine feasibility and acceptability of a tailored intervention to promote PAP adherence. PARTICIPANTS The convenience sample met inclusion criteria: newly diagnosed OSA; treatment-naïve; ≥ 18 years. EXCLUSION CRITERIA previous obstructive sleep apnea (OSA) diagnosis and treatment; new psychiatric diagnosis; use of oxygen/bilevel PAP; secondary sleep disorder. Adults (n = 118) were randomized to tailored intervention (TI; n = 61) or usual care (UC; n = 57); application of a priori exclusion criteria resulted in 30 participants per assignment who were middle-aged (51.3 ± 11.1 years) adults (70% male) with severe OSA (apnea hypopnea index [AHI], 35.9 ± 25.2). METHODS Randomized, double-blind, single-site pilot controlled trial. A multiphased tailored intervention targeting social cognitive perceptions of OSA-PAP treatment was delivered at four intervals. Descriptive analysis, group differences, and self-efficacy change scores by t-test, and thematic analysis of acceptability data are reported. RESULTS One-week PAP use among TI was 35 min greater than UC condition (p = 0.20; Cohen's d = 0.336). Treatment use decreased at 1 month and 3 months (NS). Per-protocol delivery of face-to-face intervention delivery was 100% but lower for telephone intervention delivery. Personalized approach was valued by participants. CONCLUSIONS A tailored intervention approach is acceptable to participants and feasibly implemented in a clinical sleep center setting. The intervention effect size at 1 week is consistent with other educational PAP adherence interventions but was not sustained; further pilot testing is warranted to address pilot RCT limitations.
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Affiliation(s)
- Amy M. Sawyer
- Penn State University, College of Nursing, 201 Nursing Sciences Building, University Park, Pennsylvania, 16802 U.S.A.
,Corresponding Author’s Contact Information: Amy M. Sawyer, PhD, RN, Assistant Professor, Penn State University College of Nursing, 201 Nursing Sciences Building, University Park, Pennsylvania 16802 U.S.A., Telephone (office): 1-814-863-1020, Preferred Telephone (mobile): 1-215-888-2384, Facsimile: 1-814-863-1027,
| | - Tonya S. King
- Penn State Hershey, College of Medicine, Department of Public Health Sciences, 500 University Drive, Hershey, Pennsylvania, 17033 U.S.A.
| | - Terri E. Weaver
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Avenue, Mail Code 802, Chicago, Illinois, 60612 U.S.A.
| | - Douglas A. Sawyer
- Penn State University, College of Nursing, 201 Nursing Sciences Building, University Park, Pennsylvania, 16802 U.S.A.
| | - Miranda Varrasse
- Penn State University, College of Nursing, 201 Nursing Sciences Building, University Park, Pennsylvania, 16802 U.S.A.
| | - Jamie Franks
- Penn State Milton S. Hershey Medical Center, Sleep Research and Treatment Center, Hershey Center for Applied Research, 1214 Research Boulevard, Suite 1159, Hummelstown, Pennsylvania, 17033 U.S.A.
| | - Alexa Watach
- Penn State University, College of Nursing, 201 Nursing Sciences Building, University Park, Pennsylvania, 16802 U.S.A.
| | - Ann Kolanowski
- Penn State University, College of Nursing, 201 Nursing Sciences Building, University Park, Pennsylvania, 16802 U.S.A.
| | - Kathy C. Richards
- George Mason University, School of Nursing, College of Health and Human Services 4400 University Drive, MS: 3C4, Fairfax, Virginia, 22030-4400 U.S.A.
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12
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Sankari A, Vaughan S, Bascom A, Martin JL, Badr MS. Sleep-Disordered Breathing and Spinal Cord Injury: A State-of-the-Art Review. Chest 2018; 155:438-445. [PMID: 30321507 DOI: 10.1016/j.chest.2018.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
Individuals living with spinal cord injury or disease (SCI/D) are at increased risk for sleep-disordered breathing (SDB), with a prevalence that is three- to fourfold higher than the general population. The main features of SDB, including intermittent hypoxemia and sleep fragmentation, have been linked to adverse cardiovascular outcomes including nocturnal hypertension in patients with SCI/D. The relationship between SDB and SCI/D may be multifactorial in nature given that level and completeness of injury can affect central control of respiration and upper airway collapsibility differently, promoting central and/or obstructive types of SDB. Despite the strong association between SDB and SCI/D, access to diagnosis and management remains limited. This review explores the role of SCI/D in the pathogenesis of SDB, poor sleep quality, the barriers in diagnosing and managing SDB in SCI/D, and the alternative approaches and future directions in the treatment of SDB, such as novel pharmacologic and nonpharmacologic treatments.
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Affiliation(s)
- Abdulghani Sankari
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI
| | - Sarah Vaughan
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI
| | - Amy Bascom
- John D. Dingell VA Medical Center, Detroit, MI
| | - Jennifer L Martin
- VA Greater Los Angeles Healthcare System, North Hills, CA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI.
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13
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Chaiard J, Tungpunkom P. Effectiveness of behavioral and psychosocial interventions for continuous positive airway pressure adherence in obstructive sleep apnea patients: a quantitative systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:1147-1152. [PMID: 29762308 DOI: 10.11124/jbisrir-2016-003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to assess the effectiveness of behavioral and psychosocial interventions on adherence to continuous positive airway pressure among patients 18 years and over with obstructive sleep apnea.
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Affiliation(s)
- Jindarat Chaiard
- The Thailand Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence
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14
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Sankari A, Martin JL, Badr MS. Sleep Disordered Breathing and Spinal Cord Injury: Challenges and Opportunities. CURRENT SLEEP MEDICINE REPORTS 2017; 3:272-278. [PMID: 29177130 DOI: 10.1007/s40675-017-0093-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose of review This paper focuses on the sleep disorders in patients with spinal cord injury (SCI/D), particularly mechanism of sleep disordered breathing (SDB) and challenges in diagnosis and management. Based on a review of recent literatures and studies the paper summarizes some main challenges with respect to management of SDB in patients with SCI; and what are the responsible mechanisms of disease? What are the barriers in diagnosing and treating SDB using standard treatment such as positive airway pressure (CPAP)?. Recent findings Previous studies have shown that most SCI/D patients have SDB with heterogeneity in prevalence mainly related to using different definition or methods of diagnosing SDB, while recent studies using new definition of SDB based on recommended criteria from the American Academy of Sleep Medicine (AASM) and also include the data on effect of SCI/D level on prevalence and describe different type of SDB. Furthermore, recent data describes simplified method of diagnosing SDB by using a combination of home sleep apnea testing and transcutaneous CO2 monitoring. Finally, emerging data has been pointing at strong relationship between SDB and cardiovascular disease including nocturnal hypertension in patients with SCI/D. Summary The findings indicate that early testing for SDB and associated cardiovascular disease in patients with SCI is recommended and could be beneficial in reduced the high morbidity and mortality in this group of patients with disability. In addition, studies on treatment of other sleep disorders in SCI/D are not available to inform clinical decision making. Understanding the pathophysiology of sleep disorders in SCI/D is critical for the development of new effective therapies. This review provides evidence for best practices; highlights new discoveries for the diagnosis and management of sleep disorders in SCI/D, and discuss challenges and future directions.
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Affiliation(s)
- Abdulghani Sankari
- John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Jennifer L Martin
- VA Greater Los Angeles Healthcare System, North Hills, CA, USA.,David Geffen School of Medicine at the University of California, Los Angeles
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Medicine, Wayne State University, Detroit, MI, USA
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15
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Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. Sleep Med Clin 2017; 12:551-564. [PMID: 29108610 DOI: 10.1016/j.jsmc.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.
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16
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Guralnick AS, Balachandran JS, Szutenbach S, Adley K, Emami L, Mohammadi M, Farnan JM, Arora VM, Mokhlesi B. Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial. Thorax 2017; 72:1132-1139. [PMID: 28667231 DOI: 10.1136/thoraxjnl-2017-210106] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. METHODS Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. RESULTS A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. CONCLUSIONS In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02553694.
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Affiliation(s)
- Amy S Guralnick
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jay S Balachandran
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Shane Szutenbach
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kevin Adley
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Leila Emami
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Meelad Mohammadi
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jeanne M Farnan
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Vineet M Arora
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Babak Mokhlesi
- Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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17
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Williams NJ, Jean-Louis G, Ceïde ME, Pandey A, Osorio R, Mittelman M, McFarlane SI. Effect of Maladaptive Beliefs and Attitudes about Sleep among Community-dwelling African American Men at Risk for Obstructive Sleep Apnea. ACTA ACUST UNITED AC 2017; 6. [PMID: 28845368 PMCID: PMC5568098 DOI: 10.4172/2167-0277.1000269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study compared differences in both maladaptive beliefs and attitudes about sleep between African American (heareafter referred to as black) men at risk for obstructive sleep apnea (OSA) and those without OSA risk.
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Affiliation(s)
- Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health NYU School of Medicine, New York, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health NYU School of Medicine, New York, USA
| | - Mirnova E Ceïde
- Montefiore Medical Center, Department of Psychiatry and Behavioral Science, Bronx, New York
| | - Abishek Pandey
- Department of Medicine, State University of New York-Downstate Medical Center, Brooklyn, New York, USA
| | - Ricardo Osorio
- Department of Psychiatry NYU School of Medicine, New York, New York, USA
| | - Mary Mittelman
- Department of Psychiatry and Department of Rehailitation Medicine, NYU School of Medicine, New York, USA
| | - Samy I McFarlane
- Department of Medicine, Division of Endocrinology State University of New York-Downstate Medical Center, Brooklyn, New York, USA
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18
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Abstract
Minority individuals in the United States (US) have an increased prevalence of obstructive sleep apnea (OSA) compared to their white/Caucasian counterparts. In general, adherence to positive airway pressure (PAP) therapy is poor and some studies suggest that PAP use among minority individuals is inferior to that of whites. However, there has not been a review of the evidence that addresses racial-ethnic disparities for PAP adherence in the treatment of OSA, and no review has systematically examined the contributing factors to poor adherence among minority individuals compared to whites. We searched the literature for studies published between January 1990 to July 2016 that included objective PAP use comparisons between adult US minority individuals and whites. Twenty-two studies met the inclusion criteria. All studies compared the PAP adherence of blacks to whites. Seven studies compared the PAP adherence of additional minority groups to that of whites. Sixteen of the 22 studies (73%) showed worse PAP adherence in blacks compared to whites. Four studies found equivalent PAP use in US Hispanics compared to whites. Little is known about the PAP adherence of other US minority groups. We present a framework and research agenda for understanding PAP use barriers among US minority individuals.
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19
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Iacono Isidoro S, Salvaggio A, Lo Bue A, Romano S, Marrone O, Insalaco G. Immediate effect of CPAP titration on perceived health related quality of life: a prospective observational study. BMC Pulm Med 2016; 16:172. [PMID: 27905903 PMCID: PMC5133738 DOI: 10.1186/s12890-016-0336-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perceived Health Related Quality of Life (HRQoL) is impaired in obstructive sleep apnea (OSA). This study examines changes in HRQoL aspects occurring immediately after CPAP titration. Furthermore, we analyzed variations in each gender and in patients undergoing home or laboratory-based CPAP titration pathways. METHODS Twohundredfive outpatients (151 M) (56.7 ± 10.3 years) were evaluated, before first visit and nocturnal diagnostic examination (T0), and the morning after CPAP titration (T1). Two self-reported HRQoL questionnaires were administered: Psychological General Well-Being Index (PGWBI), composed by six subscales, and 12-Item Short-Form Health Survey (SF-12), including Physical (PCS) and Mental Component Summaries (MCS). CPAP titration was performed using auto-adjusting CPAP units at patients' home or in the sleep laboratory. RESULTS PGWBI scores at T1 improved compared to T0 (p < 0.0001). A similar improvement was observed in SF-12 MCS (p = 0.0011), but not in SF-12 PCS. Changes were independent from anthropometric parameters, OSA severity and excessive daytime sleepiness. Gender comparisons showed better HRQoL in males at both times. At T0, patients who received home or laboratory CPAP titration pathways did not show any differences in PGWBI and SF-12 scores. At T1, PGWBI and SF-12 MCS improved in both home and laboratory groups. CONCLUSIONS This study gives evidence that first time CPAP application for titration can lead to a general increase in perceived well-being. Gender comparisons showed better perceived HRQoL with more subscales improvements in males after CPAP titration. The improvement was similar with both home and laboratory CPAP titration pathways.
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Affiliation(s)
- Serena Iacono Isidoro
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Adriana Salvaggio
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy.
| | - Anna Lo Bue
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Salvatore Romano
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Oreste Marrone
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Giuseppe Insalaco
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
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20
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Treatment of Obstructive Sleep Apnea. Prospects for Personalized Combined Modality Therapy. Ann Am Thorac Soc 2016; 13:101-8. [PMID: 26569377 DOI: 10.1513/annalsats.201508-537fr] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder with serious associated morbidities. Although several treatment options are currently available, variable efficacy and adherence result in many patients either not being treated or receiving inadequate treatment long term. Personalized treatment based on relevant patient characteristics may improve adherence to treatment and long-term clinical outcomes. Four key traits of upper airway anatomy and neuromuscular control interact to varying degrees within individuals to cause OSA. These are: (1) the pharyngeal critical closing pressure, (2) the stability of ventilator chemoreflex feedback control (loop gain), (3) the negative intraesophageal pressure that triggers arousal (arousal threshold), and (4) the level of stimulus required to activated upper airway dilator muscles (upper airway recruitment threshold). Simplified diagnostic methods are being developed to assess these pathophysiological traits, potentially allowing prediction of which treatment would best suit each patient. In contrast to current practice of using various treatment modes alone, model predictions and pilot clinical trials show improved outcomes by combining several treatments targeted to each patient's pathophysiology profile. These developments could theoretically improve efficacy and adherence to treatment and in turn reduce the social and economic health burden of OSA and the associated life-threatening morbidities. This article reviews OSA pathophysiology and identifies currently available and investigational treatments that may be combined in the future to optimize therapy based on individual profiles of key patient pathophysiological traits.
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21
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Hawkins SMM, Jensen EL, Simon SL, Friedman NR. Correlates of Pediatric CPAP Adherence. J Clin Sleep Med 2016; 12:879-84. [PMID: 27092702 DOI: 10.5664/jcsm.5892] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/03/2016] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. METHODS A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ(2) test. RESULTS Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. CONCLUSIONS Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.
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Affiliation(s)
- Stephen M M Hawkins
- Department of Pediatric Pulmonology, University of Colorado School of Medicine, Aurora, CO.,The Breathing Institute, Children's Hospital Colorado, Aurora, CO
| | - Emily L Jensen
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO
| | - Stacey L Simon
- Department of Pediatric Pulmonology, University of Colorado School of Medicine, Aurora, CO.,The Breathing Institute, Children's Hospital Colorado, Aurora, CO
| | - Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO
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22
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Colvin LJ, Dace GA, Colvin RM, Ojile J, Collop N. Commercial Motor Vehicle Driver Positive Airway Pressure Therapy Adherence in a Sleep Center. J Clin Sleep Med 2016; 12:477-85. [PMID: 26715403 DOI: 10.5664/jcsm.5670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/09/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess positive airway pressure (PAP) therapy adherence in commercial motor vehicle (CMV) drivers presenting to a sleep center. METHODS A retrospective chart review of 120 drivers evaluated for obstructive sleep apnea OSA and 53 initiated on PAP therapy in a single sleep center over a one-year period (2012); PAP therapy data were collected up to 1 year. RESULTS Early PAP usage best predicted adherence up to 1 year (p < 0.0001) compared to patient factors, OSA disease characteristics, and treatment elements analyzed. The proportion of participants adherent to therapy was 68.0% at 1 week, decreasing to 39.6% at 1 year, with 31.1% lost to follow-up by 1 year. In the group categorized based on adherence at week 1, 80.6% were adherent at 1 month, decreasing to 52.8% at 1 year. For the group non-adherent at 1 week, 29.4% were adherent at 1 month, decreasing to 11.7% at 1 year. Participants were predominantly male (75.8%), middle-aged (median 50.5 years), and African American (71.7%). Of those referred to the sleep center, 86.7% had OSA (median apnea-hypopnea index [AHI] or respiratory event index [REI] 20.1), with 51.0% of the OSA group having an AHI or REI > 20 and initiating PAP therapy. CONCLUSIONS Early PAP utilization patterns predicted one year adherence for our CMV driver population within a sleep clinic setting. OSA testing of these CMV drivers after occupational health referral identifies high proportions of undiagnosed OSA, with approximately half requiring PAP therapy based on current published treatment recommendations.
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Affiliation(s)
- Loretta J Colvin
- Maryville University, St. Louis, MO.,Clayton Sleep Institute, St. Louis, MO
| | | | | | | | - Nancy Collop
- Emory Sleep Center, Emory University, Atlanta, GA
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23
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Williams NJ, Jean-Louis G, Ravenell J, Seixas A, Islam N, Trinh-Shevrin C, Ogedegbe G. A community-oriented framework to increase screening and treatment of obstructive sleep apnea among blacks. Sleep Med 2016; 18:82-7. [PMID: 26652238 PMCID: PMC4908818 DOI: 10.1016/j.sleep.2015.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 07/22/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a leading sleep disorder that is disproportionately more prevalent in minority populations and is a major risk factor for cardiovascular disease (CVD) morbidity and mortality. OSA is associated with many chronic conditions including hypertension, diabetes, and obesity, all of which are disproportionately more prevalent among blacks (ie, peoples of African American, Caribbean, or African descent). METHODS This article reviews studies conducted in the United States (US) that investigated sleep screenings and adherence to treatment for OSA among blacks. In addition, guidelines are provided for implementing a practical framework to increase OSA screening and management among blacks. RESULTS Several studies have documented racial/ethnic disparities in adherence to treatment for OSA. However, despite its public health significance, there is a paucity of studies addressing these disparities. Further, there is a lack of health programs and policies to increase screening and treatment of OSA among blacks and other minority populations. A practical framework to increase the number of blacks who are screened for OSA and treated appropriately is warranted. Such a framework is timely and major importance, as early identification of OSA in this high-risk population could potentially lead to early treatment and prevention of CVD, thereby reducing racial and ethnic disparities in sleep-related CVD morbidity and mortality.
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Affiliation(s)
- Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA.
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Joeseph Ravenell
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Azizi Seixas
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Nadia Islam
- Center for Health Equity, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Chau Trinh-Shevrin
- Center for Health Equity, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
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24
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Sawyer AM, Kang Y, Honavar V, Griffin P, Prabhu V. Stimulating new and innovative perspectives on old and persistent problems: a commentary on "Attempters adherers and non-adherers: latent profile analysis of CPAP use with correlates" by Wohlgemuth et al. Sleep Med 2015; 16:311-2. [PMID: 25736372 DOI: 10.1016/j.sleep.2014.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Amy M Sawyer
- College of Nursing, The Pennsylvania State University, 201 HHD East, University Park, Pennsylvania 16802, USA.
| | - Yuncheol Kang
- College of Engineering, Department of Industrial Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Vasant Honavar
- College of Information Sciences and Technology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Paul Griffin
- College of Engineering, Department of Industrial Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Vittal Prabhu
- College of Engineering, Department of Industrial Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
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25
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Dudley KA, Patel SR. Disparities and genetic risk factors in obstructive sleep apnea. Sleep Med 2015; 18:96-102. [PMID: 26428843 DOI: 10.1016/j.sleep.2015.01.015] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/29/2014] [Accepted: 01/14/2015] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is an increasingly prevalent condition. A growing body of literature supports substantial racial disparities in the prevalence, risk factors, presentation, diagnosis, and treatment of this disease. Craniofacial structure among Asians appears to confer an elevated risk of OSA despite lower rates of obesity. Among African Americans, Native Americans, and Hispanics, OSA prevalence is increased, likely due in part to obesity. The burden of symptoms, particularly excessive daytime sleepiness, is higher among African Americans, although Hispanics more often report snoring. Limited data suggest that African Americans may be more susceptible to hypertension in the setting of OSA. While differences in genetic risk factors may explain disparities in OSA burden, no definitive genetic differences have yet been identified. In addition to disparities in OSA development, disparities in OSA diagnosis and treatment have also been identified. Increased severity of disease at diagnosis among African Americans suggests a delay in diagnosis. Treatment outcomes are also suboptimal among African Americans. In children, tonsillectomy is less likely to cure OSA and more commonly associated with complications in this group. Among adults, adherence to continuous positive airway pressure (CPAP) is substantially lower in African Americans. The reasons for these disparities, particularly in outcomes, are not well understood and should be a research priority.
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Affiliation(s)
- Katherine A Dudley
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.
| | - Sanjay R Patel
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
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26
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Risk assessment for CPAP nonadherence in adults with newly diagnosed obstructive sleep apnea: preliminary testing of the Index for Nonadherence to PAP (I-NAP). Sleep Breath 2014; 18:875-83. [PMID: 24595715 DOI: 10.1007/s11325-014-0959-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Identification of risk for continuous positive airway pressure therapy (CPAP) nonadherence prior to home treatment is an opportunity to deliver targeted adherence interventions. Study objectives included the following: (1) test a risk screening questionnaire to prospectively identify CPAP nonadherence risk among adults with newly diagnosed obstructive sleep apnea (OSA), (2) reduce the questionnaire to a minimum item set that effectively identifies 1-month CPAP nonadherence, and (3) examine the diagnostic utility of the screening index. METHODS A prospective, longitudinal study at two clinical sleep centers in the USA included adults with newly diagnosed OSA (n=97; AHI≥5 events/h) by polysomnogram (PSG) consecutively recruited to participate. After baseline participant and OSA characteristics were collected, a risk screening questionnaire was administered immediately following CPAP titration polysomnogram. One-month objective CPAP use was collected. RESULTS Predominantly, white (87%), males (55%), and females (45%) with obesity (BMI 38.3 kg/m2; SD 9.3) and severe OSA (AHI 36.8; SD 19.7) were included. One-month CPAP use was 4.25 h/night (SD 2.35). Nineteen questionnaire items (I-NAP) reliably identified nonadherers defined at <4 h/night CPAP use (Wald X2[8]=34.67, p<0.0001) with ROC AUC 0.83 (95% CI 0.74-0.91). Optimal score cut point for the I-NAP screening questionnaire were determined to maximize sensitivity (87%) while maintaining specificity>60% (63%). CONCLUSION A risk screening questionnaire employed immediately after titration PSG may reliably identify CPAP nonadherers and permit the delivery of targeted interventions to prevent or reduce nonadherence. This novel approach may enhance cost-effectiveness of care and permit appropriate allocation of resources for CPAP adherence.
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27
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Kreivi HR, Maasilta P, Bachour A. Willingness score obtained after a short CPAP trial predicts CPAP use at 1 year. Sleep Breath 2013; 18:207-13. [PMID: 23812639 DOI: 10.1007/s11325-013-0872-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/03/2013] [Accepted: 06/15/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To predict continuous positive airway pressure (CPAP) adherence at 1 year. METHODS We followed consecutive OSA patients scheduled for CPAP initiation for 1 year. Patients completed a self-efficacy questionnaire (5 = low, 25 = high score) before CPAP initiation. After CPAP initiation, we enquired about patients' satisfaction in CPAP trial and their eagerness and willingness to continue CPAP therapy (0 = unsatisfied, uneager, or refused CPAP; 100 = satisfied, eager, or willing to continue CPAP treatment). RESULTS Of the 580 patients we followed, 377 continued CPAP therapy beyond 1 year. A low willingness score (<50) was expressed by 77 patients but only 7 of them used CPAP >4 h daily at 1 year, yielding a specificity of 97 % in predicting CPAP failure. At 1 year, patients with a self-efficacy score >20, expressed prior to CPAP initiation, used CPAP more often than the patients with a score <20 (average use 4.4 ± 2.2 h vs. 3.7 ± 2.3 h, p<0.001). CONCLUSIONS A low score of willingness to continue CPAP therapy after a short trial predicts CPAP failure and poor CPAP adherence at 1 year.
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Affiliation(s)
- Hanna-Riikka Kreivi
- Sleep Unit, Division of Pulmonary Medicine, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 372, FIN-00029 HUS, Helsinki, Finland,
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