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Miller JN, Kupzyk K, Zheng C, Wichman C, Schutte-Rodin S, Gehrman P, Sawyer A, Berger AM, Balas MC. Nurse practitioner-led, virtually delivered, motivational enhancement and device support intervention to improve CPAP adherence: A feasibility randomized control trial. Heart Lung 2024; 63:119-127. [PMID: 37879189 DOI: 10.1016/j.hrtlng.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Evidence indicates continuous positive airway pressure (CPAP) therapy improves several important patient-centered outcomes. However, adherence to this safe and effective intervention remains poor. OBJECTIVES Assess nine feasibility outcomes of a nurse practitioner-led, virtually delivered motivational enhancement and device support (MENDS) intervention to improve CPAP adherence in adults with Obstructive Sleep Apnea (OSA). Secondary aims compared the changes in CPAP adherence to patient-reported outcomes, patient activation, and perceived self-efficacy. METHODS This two-group feasibility randomized controlled trial included 29 patients newly diagnosed with OSA and prescribed CPAP therapy. The study was conducted from July 2020 through December 2021 at a midwestern sleep/pulmonary clinic. Participants were randomized to the MENDS intervention group (n=14) (30-45 minute interactive tele-discussions on weeks 2, 4, 6, and 8) or to the usual care (n=15) group. Feasibility, patient-reported outcomes, and behavioral constructs were measured at baseline and 12 weeks. CPAP adherence was measured weekly. RESULTS Feasibility of the MENDS sessions was demonstrated (56 sessions offered, 52 completed remotely without technical difficulties) with minimal participant attrition and no missing CPAP data. Generalized linear mixed models showed no statistically significant time-by-group interactions on adherence or patient-reported outcomes. Higher adherence and lower CPAP apnea-hypopnea index (AHI) scores were associated with declines in pre- to post-changes in fatigue and sleep disturbance. Lower CPAP AHI scores were associated with pre- to post-decreases in PROMIS Anxiety scores (r=.532, p=.005). CONCLUSION The virtual MENDS intervention was feasible. Higher CPAP adherence and lower AHI levels led to positive improvements in fatigue, sleep disturbance, and anxiety.
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Affiliation(s)
- Jennifer N Miller
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198; Nebraska Pulmonary Specialties, LLC, 1500 S. 48(th) St. #800, Lincoln, NE 68506.
| | - Kevin Kupzyk
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198
| | - Cheng Zheng
- The University of Nebraska Medical Center College of Public Health, 40th and Dewey Ave, Omaha, NE 68198
| | - Chris Wichman
- The University of Nebraska Medical Center College of Public Health, 40th and Dewey Ave, Omaha, NE 68198
| | - Sharon Schutte-Rodin
- Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Philip Gehrman
- Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Amy Sawyer
- Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104; The University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104
| | - Ann M Berger
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198
| | - Michele C Balas
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Lévy P, Schiza S. Are type III devices the future of sleep disordered breathing management? Eur Respir J 2023; 61:61/1/2201947. [PMID: 36609521 DOI: 10.1183/13993003.01947-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Patrick Lévy
- HP2 Laboratory, Univ. Grenoble Alpes, Inserm, Grenoble, France
- Sleep Laboratory, EFCR, Grenoble University Hospital, Grenoble, France
| | - Sophia Schiza
- Dept of Respiratory Medicine, Sleep Disorders Centre, School of Medicine, University of Crete, Heraklion, Greece
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Crosby ES, Spitzer EG, Kavookjian J. Motivational Interviewing Effects on Positive Airway Pressure Therapy (PAP) Adherence: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Behav Sleep Med 2022:1-28. [PMID: 36018794 DOI: 10.1080/15402002.2022.2108033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis examined Motivational Interviewing (MI) effects on positive airway pressure (PAP) adherence and related outcomes. METHOD Medline, CIHANL, Psych Info, Web of Science, PubMed, and Cochrane Database of Systematic Reviews were searched for randomized controlled trials published from peer-reviewed journals in English from 1990 to 2021 that compared objective PAP adherence among adults with obstructive sleep apnea (OSA) in a MI and non-MI intervention. A random effects meta-analysis model was completed at the 1-to-2-week, and 1-, 2-, 3-, and 12-month follow-up, and risk of bias was analyzed with the Cochrane Risk of Bias Tool. RESULTS In 10 trials of naïve PAP users and one trial of non-naïve PAP users, 14 to 277 middle-aged adults with moderate-to-severe OSA generally engaged in a brief, individual, face-to-face, MI intervention with standard care or a control condition. Several trials of naïve PAP users demonstrated that MI increased PAP use 1-2.6 hours per night, but a similar number of trials showed comparable conditions. Secondary outcomes were mixed. Among non-naïve PAP users, MI did not significantly increase adherence or secondary outcomes. The meta-analysis of PAP-naïve participants revealed that MI had a small to moderate significant effect on PAP adherence at 1, 2, and 3 months after beginning PAP (Hedges' g = 0.38 to 0.48; 95% CI = 0.04, 0.75) compared to standard care alone. CONCLUSIONS Despite heterogeneity, MI moderately increased PAP adherence among PAP-naïve adults with moderate-to-severe OSA, suggesting an effective strategy for short-term (1-3 months) adherence.
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Affiliation(s)
- Eric S Crosby
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Elizabeth G Spitzer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jan Kavookjian
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama, USA
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Xanthopoulos MS, Williamson AA, Tapia IE. Positive airway pressure for the treatment of the childhood obstructive sleep apnea syndrome. Pediatr Pulmonol 2022; 57:1897-1903. [PMID: 33647183 PMCID: PMC8408267 DOI: 10.1002/ppul.25318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/28/2022]
Abstract
In this review, we have summarized the benefits of treatment with positive airway pressure for the childhood obstructive sleep apnea syndrome and presented a socio-ecological framework to enhance our understanding of positive airway pressure adherence predictors and important targets of comprehensive positive airway pressure treatment models across different pediatric populations. Although positive airway pressure is clearly a beneficial treatment for pediatric obstructive sleep apnea syndrome, additional research is needed to evaluate how socio-ecological factors may interact to predict positive airway pressure adherence, with more attention to the impact of the broader healthcare setting and on treatment approaches and outcomes in special pediatric populations.
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Affiliation(s)
- Melissa S Xanthopoulos
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariel A Williamson
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ignacio E Tapia
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kosky C, Madeira N, Boulton K, Hunter MT, Ling I, Reynor A, Sturdy G, Walsh J, Dhaliwal S, Singh B, Eastwood P, McArdle N. Telemedicine compared to standard face-to-face care for CPAP treatment: real-world Australian experience. Sleep 2022; 45:6643327. [PMID: 35830509 DOI: 10.1093/sleep/zsac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/21/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES We tested a telemedicine model of care to initiate continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA) living in remote Western Australia. METHODS A prospective study comparing telemedicine for CPAP initiation in a remote population versus standard face-to-face CPAP initiation in a metropolitan population. The primary outcome was average nightly CPAP use in the final week of a CPAP trial. RESULTS A total of 186 participants were allocated to either telemedicine (n=56) or standard care (n=130). The average distance from the study centre for the telemedicine group was 979 km (±792km) compared to 19km (±14km) for the standard care group. The CPAP trial duration in the standard care group was less than the telemedicine group (37.6 vs 69.9 days, p<0.001). CPAP adherence in the telemedicine group was not inferior to standard care (Standard 4.7±0.2 hours, Telemedicine 4.7±0.3 hours, p=0.86). No differences were found between groups in residual apnea-hypopnea index, symptom response, sleep specific quality of life at the end of the trial and continued CPAP use (3 to 6 months). Participant satisfaction was high in both groups. Total health care costs of the telemedicine model were less than the standard model of care. An estimated A$4,538 per participant in travel costs was saved within the telemedicine group by reducing the need to travel to the sleep center for in-person management. CONCLUSIONS In remote dwelling adults starting CPAP for the treatment of OSA, outcomes using telemedicine were comparable to in-person management in a metropolitan setting.
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Affiliation(s)
- Christopher Kosky
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Neill Madeira
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Kate Boulton
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Marie-Therese Hunter
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Ivan Ling
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Ayesha Reynor
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Gavin Sturdy
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Jennifer Walsh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Satvinder Dhaliwal
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore.,Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia.,Singapore University of Social Sciences, Office of the Provost. 463 Clementi Road, Singapore
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Peter Eastwood
- Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, South Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
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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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8
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Shaukat R, Gamal Y, Ali A, Mohamed S. Adherence to Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea. Cureus 2022; 14:e25946. [PMID: 35855223 PMCID: PMC9286015 DOI: 10.7759/cureus.25946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/27/2022] Open
Abstract
Adherence to either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) therapy in patients with obstructive sleep apnea syndrome (OSAS) represents a real challenge to sleep medicine physicians. Many risk factors/predictors for nonadherence exist, and usually, it is multifactorial. Long-term nonadherence with CPAP therapy has been associated with the use of CPAP for <4 hours/night during early treatment, moderate to severe obstructive sleep apnea (OSA), poor self-efficacy, and unsupportive bed partner. The American Academy of Sleep Medicine (AASM) recommends follow-up of patients with OSA within the first two weeks of CPAP use to optimize adherence. Measures to improve adherence to positive airway pressure (PAP) therapy go through an integrated approach that involves behavioral therapy and prompt management of side effects. Pharmacologic therapy in the form of a sedative-hypnotic sleep aid has a minor role in managing nonadherence to CPAP based on the greater risk of side effects. This article will briefly discuss the risk factors and management of nonadherence to PAP therapy in patients with OSAS.
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Giménez S, Farre A, Morente F, Videla L, Gutiérrez M, Clos S, Fernández A, Blanco M, Altuna M, Pegueroles J, Asensio A, Benejam B, Batista M, Barroeta I, Fortuna A, Fortea J, Mayos M. Feasibility and Long-Term Compliance to Continuous Positive Airway Pressure Treatment in Adults With Down Syndrome, a Genetic Form of Alzheimer’s Disease. Front Neurosci 2022; 16:838412. [PMID: 35431793 PMCID: PMC9005794 DOI: 10.3389/fnins.2022.838412] [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: 12/17/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDown syndrome (DS) is a genetic form of Alzheimer’s disease (AD) with a high prevalence of obstructive sleep apnea (OSA). These characteristics place the DS population as an optimal model to study the relationship between sleep and AD and to design clinical trials of preventive sleep therapies for AD. Regrettably, OSA treatment with continuous positive airway pressure (CPAP) is often neglected in adults with DS. In both clinical practice and research trials, it is usually presumed that these patients will not adapt to or tolerate the therapy.Study ObjectiveWe aimed to evaluate the feasibility and long-term CPAP compliance in this population and their capacity to be enrolled in CPAP research studies.MethodsWe prospectively compared the CPAP compliance of 17 OSA patients with DS and 19 age and sex matched OSA euploid patients. CPAP management and follow-up schedules were prescribed according to the habitual clinical practice. We compared group differences in tolerance, objective, and subjective hours of nightly CPAP usage at the 1st, 3rd, 6th, 12th, 24th, and 36th month visits. Good compliance was defined as at least 4 h use per night. We also investigated predictive factors of long-term CPAP compliance.ResultsThe percentage of DS subjects with good CPAP compliance (81.2 vs. 78.9%) and the objective CPAP use (5 vs. 6 h, p = 0.92) did not differ from the control group (CG). Subjective CPAP compliance was significantly higher in OSA patients with DS than in controls in all the follow-up visits (8 vs. 6.75 h, p = 0.001). The DS group had a significantly higher number of visits (9 vs. 5; p = 0.021) and mask changes (2.5 vs. 2; p = 0.05) than controls. Objective hours of CPAP use at the first follow-up visit predicted long-term CPAP compliance (p < 0.005).ConclusionCPAP treatment is feasible and has good long-term compliance in OSA patients with DS. It should be recommended to improve health and prevent comorbidities. The DS population is indeed suitable to participate in longitudinal preventive sleep clinical trials for AD.
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Affiliation(s)
- Sandra Giménez
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
- *Correspondence: Sandra Giménez,
| | - Ariadna Farre
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Fátima Morente
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Laura Videla
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Marta Gutiérrez
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Susana Clos
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Fernández
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Marta Blanco
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Jordi Pegueroles
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amparo Asensio
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Bessy Benejam
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Mar Batista
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Ana Fortuna
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Mercedes Mayos
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERNED), Madrid, Spain
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10
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Bertrand M, Bastien C, Boutin I, Vallières A. A psychological view on the effectiveness of psychosocial interventions on positive airway pressure treatment adherence and sleep quality in patients with obstructive sleep apnea. Sleep Med 2022; 91:62-74. [DOI: 10.1016/j.sleep.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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11
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APAP, BPAP, CPAP, and New Modes of Positive Airway Pressure Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:297-330. [PMID: 36217092 DOI: 10.1007/978-3-031-06413-5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Positive airway pressure (PAP) is the primary treatment of sleep-disordered breathing including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Just as clinicians use pharmacological mechanism of action and pharmacokinetic data to optimize medication therapy for an individual, understanding how PAP works and choosing the right mode and device are critical to optimizing therapy in an individual patient. The first section of this chapter will describe the technology inside PAP devices that is essential for understanding the algorithms used to control the airflow and pressure. The second section will review how different comfort settings including ramp and expiratory pressure relief and modes of PAP therapy including continuous positive airway pressure (CPAP), autotitrating CPAP, bilevel positive airway pressure, adaptive servoventilation, and volume-assured pressure support control the airflow and pressure. Proprietary algorithms from several different manufacturers are described. This chapter derives its descriptions of algorithms from multiple sources including literature review, manufacture publications and websites, patents, and peer-reviewed device comparisons and from personal communication with manufacturer representatives. Clinical considerations related to the technological aspects of the different algorithms and features will be reviewed.
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12
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Rethorn ZD, Bezner JR, Pettitt CD. From expert to coach: health coaching to support behavior change within physical therapist practice. Physiother Theory Pract 2021; 38:2352-2367. [PMID: 34620046 DOI: 10.1080/09593985.2021.1987601] [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] [Indexed: 11/12/2022]
Abstract
Background: Negative health behaviors are a significant risk factor for non-communicable diseases (NCDs) and are responsible for 40-50% of the burden of disease in the US population. Physical therapists (PTs) have the capacity to effect behavior change in their patients to reduce their risk of disease and promote health. Competence in health behavior change is recommended for physical therapists. One way to achieve this competence is by learning and adopting a health coaching approach. Objectives: To provide a theoretical and practical approach to applying a health coaching approach in physical therapist clinical practice. Methods: 1) Describe a health coaching approach to facilitating behavior change; 2) present behavior change theories, communication strategies, and models underpinning health coaching; and 3) provide suggestions for ways PTs can integrate health coaching in clinical practice. Results: Health coaching is a dynamic and collaborative approach to health behavior change that harnesses the patient's or client's values and strengths to realize their goals for health. Conclusion: Adopting a health coaching approach may enhance adherence to physical therapists' recommendations as well as improve health outcomes.
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Affiliation(s)
- Zachary D Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA.,Rocky Mountain University of Health Professions, Provo, UT, USA
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, 601 University Dr, Round Rock, TX, USA
| | - Cherie D Pettitt
- Rocky Mountain University of Health Professions, Provo, UT, USA.,WGU Academy, Western Governors University, Salt Lake City, Ut, USA
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13
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Scarpina F, Bastoni I, Cappelli S, Priano L, Giacomotti E, Castelnuovo G, Molinari E, Tovaglieri IMA, Cornacchia M, Fanari P, Mauro A. Short-Term Effects of a Multidisciplinary Residential Rehabilitation Program on Perceived Risks, Confidence Toward Continuous Positive Airway Pressure Treatment, and Self-Efficacy in a Sample of Individuals Affected by Obstructive Sleep Apnea Syndrome. Front Psychol 2021; 12:703089. [PMID: 34484053 PMCID: PMC8416346 DOI: 10.3389/fpsyg.2021.703089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022] Open
Abstract
Continuous positive airway pressure (CPAP) therapy is the standard treatment for obstructive sleep apnea (OSA) syndrome. However, optimizing adherence to CPAP therapy of individuals remains very challenging for clinicians because of the role played by the psychological components. In this study, we verified the changes in cognitions and beliefs of individuals after a four-week multidisciplinary residential rehabilitation program targeting the adaptation to CPAP therapy for OSA syndrome. We assessed the components of perceived risks, confidence toward the treatment, and self-efficacy through the self-report questionnaire, namely the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. We also explored the role played by the temperamental traits on the changes registered in these components after the treatment. Forty-five participants completed the rehabilitation program, showing a higher level of adherence to the treatment. Significant changes were observed in terms of confidence toward the treatment, although no change was reported in terms of perceived risks and self-efficacy. Moreover, those individuals with a higher persistent temperamental trait reported a significant improvement in perceived risks, in the absence of other significant results. After the rehabilitation treatment, our participants were more prone to consider the effect of CPAP treatment on health outcomes. This was in line with the educational aim of the rehabilitation treatment. The temperament seemed to play only a marginal role in the global changes reported by our participants. We discussed the need for behavioral interventions, in addition to education, in improving self-efficacy.
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Affiliation(s)
- Federica Scarpina
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, Italy.,"Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy
| | - Ilaria Bastoni
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, Piancavallo, Italy
| | - Simone Cappelli
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, Piancavallo, Italy
| | - Lorenzo Priano
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, Italy.,"Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy
| | - Emanuela Giacomotti
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, Italy
| | - Gianluca Castelnuovo
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, Piancavallo, Italy.,Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Enrico Molinari
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, Piancavallo, Italy.,Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Mauro Cornacchia
- Istituto Auxologico Italiano, IRCCS, U.O. di Riabilitazione Pneumologica, Ospedale S. Giuseppe, Piancavallo, Italy
| | - Paolo Fanari
- Istituto Auxologico Italiano, IRCCS, U.O. di Riabilitazione Pneumologica, Ospedale S. Giuseppe, Piancavallo, Italy
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, Italy.,"Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy
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14
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Szekeres M, MacDermid JC. Online learning versus workshops: a rank minimized trial comparing the effect of two knowledge translation strategies designed to alter knowledge, readiness to change, and self-efficacy with respect to rehabilitation outcome measures. Disabil Rehabil 2021; 44:6531-6538. [PMID: 34455882 DOI: 10.1080/09638288.2021.1965227] [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: 10/20/2022]
Abstract
PURPOSE Traditional face-to-face learning is often replaced by virtual learning because it can be more feasible and cost-effective, and more recently due to the need for social distancing. The objective was to evaluate the effectiveness of two innovative knowledge translation (KT) interventions; in-person stakeholder-hosted, interactive, problem-based seminars (SHIPS) versus online problem-based tutorials (e-PBL) in changing knowledge, readiness to change, and self-efficacy with respect to the use of rehabilitation outcome measures. METHODS Physical and occupational therapists (n = 124) were recruited from four sites across Canada to participate in either an e-PBL or SHIPS. Evaluations of KT impact measured knowledge, self-efficacy to implement outcome measures in practice, and readiness to change. RESULTS There were 112 participants who completed the study. Following the intervention, the mean knowledge scores for both groups improved, but there was greater improvement in participants who completed SHIPS. For self-efficacy and readiness to change, there was no significant difference between groups six months following the interventions. E-PBL was as good as a SHIPS for improving and retaining self-efficacy and readiness to change. CONCLUSIONS Knowledge improved more with workshops than online delivery, while improvements in self-efficacy and readiness to change improved similarly regardless of delivery.Implications for RehabilitationThis study compared the relative efficacy of internet and workshop-based education, focusing specifically on the use of outcome measures in physical and occupational therapy practice.Improvements in the self-efficacy of rehabilitation professionals with respect to outcome measure use had lasting effects regardless of KT intervention type, as it was retained six months following the intervention.Results from this study show that online interventions may be as effective as face-to-face workshops for improving readiness to change and self-efficacy for using outcome measures in practice by rehabilitation professionals.This is valuable information given the recent global pandemic, the need for social distancing, and the potential for learning interventions to focus within the online environment in the future.
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Affiliation(s)
- Mike Szekeres
- Lawson Health Research Institute, London, Canada.,The Roth McFarlane Hand and Upper Limb Centre, London, Canada
| | - Joy C MacDermid
- Health and Rehabilitation Sciences, Western University, London, Canada.,The Roth McFarlane Hand and Upper Limb Centre, London, Canada
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15
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Rapelli G, Pietrabissa G, Manzoni GM, Bastoni I, Scarpina F, Tovaglieri I, Perger E, Garbarino S, Fanari P, Lombardi C, Castelnuovo G. Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front Psychol 2021; 12:705364. [PMID: 34475840 PMCID: PMC8406627 DOI: 10.3389/fpsyg.2021.705364] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/09/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of motivational interventions to increase adherence to Continuous Positive Airway Pressure (CPAP) among patients with Obstructive Sleep Apnea Syndrome (OSAS) and of their specific aspects and strategies by assessing adherence measures. Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the concepts of "obstructive sleep apnea syndrome," "continuous positive airway pressure," "motivational intervention," and "adherence." Rigorous inclusion criteria and screening by at least two reviewers were applied. Data were extracted to address the review aims and were presented as a narrative synthesis. Results: Search for databases produced 11 randomized controlled trials, all including naïve CPAP users. Findings showed that motivational interventions were more effective than usual care and educational programs in increasing adherence to CPAP, despite results were not always maintained over time across studies. Discussion: To our knowledge, this is the first scoping review of the literature aimed to explore the characteristics and impact of motivational interventions to promote adherence to CPAP in patients with OSAS. More research providing a detailed description of motivational strategies, and testing of their association with positive treatment outcomes via both direct and indirect measures are needed to increase awareness on active mechanisms of change.
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Affiliation(s)
- Giada Rapelli
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy,Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Ilaria Bastoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Federica Scarpina
- U. O. di Neurologia e Neuroriabilitazione, Istituto Auxologico Italiano IRCCS, Verbania, Italy,“Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Ilaria Tovaglieri
- Pulmonary Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Elisa Perger
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Instituto Auxologico Italiano IRCCS, Milan, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences, University of Genoa, Genoa, Italy
| | - Paolo Fanari
- Pulmonary Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Verbania, Italy,*Correspondence: Paolo Fanari
| | - Carolina Lombardi
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Instituto Auxologico Italiano IRCCS, Milan, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
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16
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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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17
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Kooij L, Vos PJ, Dijkstra A, Roovers EA, van Harten WH. Video Consultation as an Adequate Alternative to Face-to-Face Consultation in Continuous Positive Airway Pressure Use for Newly Diagnosed Patients With Obstructive Sleep Apnea: Randomized Controlled Trial. JMIR Form Res 2021; 5:e20779. [PMID: 33973866 PMCID: PMC8150406 DOI: 10.2196/20779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/25/2020] [Accepted: 04/13/2021] [Indexed: 01/29/2023] Open
Abstract
Background The effectiveness of continuous positive airway pressure (CPAP) is dependent on the degree of use, so adherence is essential. Cognitive components (eg, self-efficacy) and support during treatment have been found to be important in CPAP use. Video consultation may be useful to support patients during treatment. So far, video consultation has rarely been evaluated in thorough controlled research, with only a limited number of outcomes assessed. Objective The aim of the study was to evaluate the superiority of video consultation over face-to-face consultation for patients with obstructive sleep apnea (OSA) on CPAP use (minutes per night), adherence, self-efficacy, risk outcomes, outcome expectancies, expectations and experiences with video consultation, and satisfaction of patients and nurses. Methods A randomized controlled trial was conducted with an intervention (video consultation) and a usual care group (face-to-face consultation). Patients with confirmed OSA (apnea-hypopnea index >15), requiring CPAP treatment, no history of CPAP treatment, having access to a tablet or smartphone, and proficient in the Dutch language were recruited from a large teaching hospital. CPAP use was monitored remotely, with short-term (weeks 1 to 4) and long-term (week 4, week 12, and week 24) assessments. Questionnaires were completed at baseline and after 4 weeks on self-efficacy, risk perception, outcome expectancies (Self-Efficacy Measure for Sleep Apnea), expectations and experiences with video consultation (covering constructs of the unified theory of acceptance and use of technology), and satisfaction. Nurse satisfaction was evaluated using questionnaires. Results A total of 140 patients were randomized (1:1 allocation). The use of video consultation for OSA patients does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. A significant difference in change over time was found between groups for short-term (P-interaction=.008) but not long-term (P-interaction=.68) CPAP use. CPAP use decreased in the long term (P=.008), but no significant difference was found between groups (P=.09). Change over time for adherence was not significantly different in the short term (P-interaction=.17) or long term (P-interaction=.51). A relation was found between CPAP use and self-efficacy (P=.001), regardless of the intervention arm (P=.25). No significant difference between groups was found for outcome expectancies (P=.64), self-efficacy (P=.41), and risk perception (P=.30). The experiences were positive, and 95% (60/63) intended to keep using video consultation. Patients in both groups rated the consultations on average with an 8.4. Overall, nurses (n=3) were satisfied with the video consultation system. Conclusions Support of OSA patients with video consultation does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. The findings of this research suggest that self-efficacy is an important factor in improving CPAP use and that video consultation may be a feasible way to support patients starting CPAP. Future research should focus on blended care approaches in which self-efficacy receives greater emphasis. Trial Registration Clinicaltrials.gov NCT04563169; https://clinicaltrials.gov/show/NCT04563169
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Affiliation(s)
- Laura Kooij
- Rijnstate, Arnhem, Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Petra Je Vos
- Pulmonary Department, Rijnstate, Arnhem, Netherlands
| | | | | | - Wim H van Harten
- Rijnstate, Arnhem, Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
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18
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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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20
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Andry JM, Toban G, Chafin C, Noah W. Positive airway pressure therapy supplied by an integrated sleep practice associated with greater adherence among pre-Medicare-aged patients with sleep-disordered breathing. J Clin Sleep Med 2021; 17:31-36. [PMID: 32895117 DOI: 10.5664/jcsm.8786] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We investigated whether patient adherence to positive airway pressure (PAP) therapy was significantly different between groups whose PAP machines were dispensed by a traditional durable medical equipment (DME) supplier (DME group) versus those provided directly by an integrated sleep practice (ISP group). METHODS This was a retrospective cohort study that analyzed 3884 patients (ages 18-64) who were set up with a new PAP machine for sleep-disordered breathing. The channel through which PAP therapy was dispensed (DME vs ISP) was chosen as part of the natural course of treatment, making patient choice and third-party payor likely important selection factors. We analyzed whether the groups had significant differences in adherence rates and nightly usage duration after 30 days, 90 days, and 1 year of therapy. RESULTS The ISP group had a significantly higher rate of PAP adherence at 30 days (71% vs 66%; P = .004), 90 days (66% vs 56%; P < .00001), and 1 year (52% vs 33%; P < .00001) following initiation of PAP therapy, relative to the DME group. There was a significantly higher duration of PAP use among the ISP group at 30 days (357 vs 345 minutes; P = .002), 90 days (348 vs 319 minutes; P < .00001), and 1 year (312 vs 164 minutes; P < .00001). CONCLUSIONS This study suggests improved short- and long-term PAP adherence rates among patients who received PAP therapy through an ISP. As current health care trends drive sleep medicine practices to adopt chronic care management models, further studies are needed to better understand the tradeoffs of receiving PAP through traditional DME providers.
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Affiliation(s)
- James M Andry
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gabriel Toban
- MTSU Center for Health and Human Services Sleep Research Consortium, Middle Tennessee State University, Murfreesboro, Tennessee
| | - Cynthia Chafin
- MTSU Center for Health and Human Services Sleep Research Consortium, Middle Tennessee State University, Murfreesboro, Tennessee
| | - William Noah
- Sleep Centers of Middle Tennessee, MTSU Center for Health and Human Services Sleep Research Consortium, Middle Tennessee State University, Murfreesboro, Tennessee
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Willard-Grace R, Wolf J, Huang B, Lewis E, Su G. Pilot of Brief Health Coaching Intervention to Improve Adherence to Positive Airway Pressure Therapy. Jt Comm J Qual Patient Saf 2020; 46:631-639. [PMID: 32972868 DOI: 10.1016/j.jcjq.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adherence to positive airway pressure (PAP) therapies is poor, particularly among low-income populations and racial minorities. This study tested a low-resource, brief telephonic health coaching intervention to improve PAP adherence. METHODS Post hoc analysis of a quality improvement initiative in which English- and Spanish-speaking patients from a county-based public health system were randomly assigned to receive health coaching or usual care. An unlicensed, trained health coach called patients three times to resolve barriers to adherence. A per-protocol analysis was conducted for adherence measures collected by device modem at baseline and 30 days. RESULTS Of 131 people for whom device data were available, 56 were randomized to health coaching and 75 to usual care. At baseline, 47.3% of patients had used their device at any time in the past 30 days, with a mean of 2 hours of use per night. At 30 days, adjusting for baseline, patients in the coaching arm were more likely than usual care patients to use their device (55.4% vs. 41.3%, p = 0.03), and they increased their use for 0.4 hours over usual care (p = 0.04). CONCLUSION This pilot study suggests that a low-cost intervention could be effective at improving PAP adherence, even in a population known to have poor adherence and among long-term PAP users with poor adherence. Future research may examine whether a higher-touch intervention or one using videoconferencing yields greater improvements. This promising intervention warrants further study.
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22
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Should Multilevel Phase I Surgical Therapy be Recommended as Treatment for Moderate Obstructive Sleep Apnea due to Oropharyngeal and Hypopharyngeal Obstruction? J Oral Maxillofac Surg 2020; 78:2282-2288. [PMID: 32898482 DOI: 10.1016/j.joms.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of multilevel phase I surgery for the treatment of moderate obstructive sleep apnea (OSA) in retrognathic patients with oropharyngeal and hypopharyngeal obstruction. MATERIALS AND METHODS This was a 10-year retrospective cohort study of patients treated by a single surgeon at the Boston University Medical Center. From 2000 to 2010, retrognathic patients with moderate OSA and verified palatal and tongue base obstruction were treated with multilevel phase I surgery that included uvulopalatopharyngoplasty, hyoid suspension, and genioglossus advancement. All patients were evaluated clinically and received polysomnographic studies at three time points: preoperatively (T1), between 6 and 12 months postoperatively (T2), and a minimum of 24 months postoperatively (T3). RESULTS Twenty-five subjects composed the final study sample. At T2, 11 patients (44.0%) experienced a complete response, 13 (52.0%) experienced a partial response, and 1 (4.0%) experienced no response. Although phase I surgery was associated with significant changes in AHI (F(2,48) = 119.3; P < .01) throughout the follow-up period, only one patient at T3 (4.0%) met the criteria for a complete response. The remaining patients were divided evenly between partial response (48.0%) and treatment failure (48.0%), of whom 4 (16.0%) patients had worsening of their obstruction. Thirteen of these patients subsequently elected to undergo maxillomandibular advancement, while 11 elected to continue using continuous positive airway pressure. CONCLUSIONS Although phase I surgery was associated with AHI changes, this reduction was not sufficient to produce a long-term treatment response in over half of our patients. Treatment response was worse after 2 years than at 6 to 12 months. Patients with moderate OSA should understand that multilevel phase I surgery has a greater chance of failure than success and that transient improvements may not be durable.
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Grandner MA, Olivier K, Gallagher R, Hale L, Barrett M, Branas C, Killgore WDS, Parthasarathy S, Gehrels JA, Alfonso-Miller P. Quantifying impact of real-world barriers to sleep: The Brief Index of Sleep Control (BRISC). Sleep Health 2020; 6:587-593. [PMID: 32482573 DOI: 10.1016/j.sleh.2020.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Lack of control over sleep may contribute to population-level sleep disturbances, yet relatively little work has explored the degree to which an individual's sense of control over their sleep may represent an important factor. METHODS Data from the Sleep and Healthy Activity Diet Environment and Socialization (SHADES) study, conducted in the Philadelphia area on a population comprising 1,007 individuals aged 22-60 years, was used. The BRief Index of Sleep Control (BRISC) was developed to quantify the degree to which an individual has control over their sleep. Reliability of the BRISC was assessed using Cronbach's alpha. Convergent validity was assessed by examining age-adjusted items and total score relationships to insomnia (ISI), sleepiness (ESS), sleep quality (PSQI), and total sleep time (NHANES). RESULTS After adjustment for covariates, greater control over sleep was associated with a lower PSQI score (B = -2.2, 95% CI [-2.4,-2.0], P < .0001), lower ISI score (B = -3.1, 95% CI [-3.5,-2.7], P < .0001), lower ESS score (B=-1.4, 95% CI [-1.7,-1.1], P < .0001), and more hours of sleep duration (B = 0.5, 95% CI [0.4,0.6], P < .0001). Each BRISC item was separately associated with each sleep outcome (P < .0001), although the items were not collinear with each other (all R<0.7). Thus, the BRISC instrument demonstrated high reliability and good validity. CONCLUSIONS Control over sleep may represent an important factor in sleep health. Control over time to bed, time awake, sleep duration, and sleep quality are all related to sleep outcomes and assessment of these constructs may be useful for future sleep interventions.
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Affiliation(s)
- Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ; UAHS Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ.
| | - Kayla Olivier
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Rebecca Gallagher
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Lauren Hale
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Marna Barrett
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Charles Branas
- Department of Epidemiology and Biostatistics, Columbia University, New York, NY
| | | | | | - Jo-Ann Gehrels
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
| | - Pamela Alfonso-Miller
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona, Tucson, AZ
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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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Howard J, Lee SA, Inusa B, Cheng MYE, Bavenjit C, Reading IC, Wakeford SA, Gavlak JC, Murphy PB, Hart N, Gupta A, Sahota S, Jacob E, Chorozoglou M, Ossai C, Gwam M, Kirkham FJ, Wade AM, Liossi C. Prevention of Morbidity in Sickle Cell Disease (POMS2a)-overnight auto-adjusting continuous positive airway pressure compared with nocturnal oxygen therapy: a randomised crossover pilot study examining patient preference and safety in adults and children. Trials 2019; 20:442. [PMID: 31319882 PMCID: PMC6637584 DOI: 10.1186/s13063-019-3461-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
DESIGN This randomised crossover trial compared nocturnal auto-adjusting continuous positive airway pressure (APAP) and nocturnal oxygen therapy (NOT) in adults and children with sickle cell anaemia, with patient acceptability as the primary outcome. Secondary outcomes included pulmonary physiology (adults), safety, and daily pain during interventions and washout documented using tablet technology. METHODS Inclusion criteria were age > 8 years and the ability to use an iPad to collect daily pain data. Trial participation was 4 weeks; week 1 involved baseline data collection and week 3 was a washout between interventions, which were administered for 7 days each during weeks 2 and 4 in a randomised order. Qualitative interviews were transcribed verbatim and analysed for content using a funnelling technique, starting generally and then gaining more detailed information on the experience of both interventions. Safety data included routine haematology and median pain days between each period. Missing pain day values were replaced using multiple imputation. RESULTS Ten adults (three female, median age 30.2 years, range 18-51.5 years) and eleven children (five female, median age 12 years, range 8.7-16.9 years) enrolled. Nine adults and seven children completed interviews. Qualitative data revealed that the APAP machine was smaller, easier to handle, and less noisy. Of 16 participants, 10 preferred APAP (62.5%, 95% confidence interval (CI) 38.6-81.5%). Haemoglobin decreased from baseline on APAP and NOT (mean difference -3.2 g/L (95% CI -6.0 to -0.2 g/L) and -2.5 g/L (95% CI -4.6 to 0.3 g/L), respectively), but there was no significant difference between interventions (NOT versus APAP, 1.1 (-1.2 to 3.6)). Pulmonary function changed little. Compared with baseline, there were significant decreases in the median number of pain days (1.58 for APAP and 1.71 for NOT) but no significant difference comparing washout with baseline. After adjustment for carry-over and period effects, there was a non-significant median difference of 0.143 (95% CI -0.116 to 0.401) days additional pain with APAP compared with NOT. CONCLUSION In view of the point estimate of patient preference for APAP, and no difference in haematology or pulmonary function or evidence that pain was worse during or in washout after APAP, it was decided to proceed with a Phase II trial of 6 months APAP versus standard care with further safety monitoring for bone marrow suppression and pain. TRIAL REGISTRATION ISRCTN46078697 . Registered on 18 July 2014.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sophie A Lee
- Centre for Applied Statistics Courses, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Baba Inusa
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | | | - Isabel C Reading
- Research Design Service, University Hospital Southampton, Southampton, UK
| | - Sally Ann Wakeford
- Department of Child Health, University Hospital Southampton, Southampton, UK
| | - Johanna C Gavlak
- Department of Child Health, University Hospital Southampton, Southampton, UK.,Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Patrick B Murphy
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Hart
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Sati Sahota
- Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Eufemia Jacob
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria Chorozoglou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Carol Ossai
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Maureen Gwam
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Fenella J Kirkham
- Department of Child Health, University Hospital Southampton, Southampton, UK. .,Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. .,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Angela M Wade
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Christina Liossi
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Psychology, University of Southampton, Southampton, UK.,Department of Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Cayanan EA, Bartlett DJ, Chapman JL, Hoyos C, Phillips CL, Grunstein RR. A review of psychosocial factors and personality in the treatment of obstructive sleep apnoea. Eur Respir Rev 2019; 28:28/152/190005. [DOI: 10.1183/16000617.0005-2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023] Open
Abstract
Effective treatment of obstructive sleep apnoea (OSA) is primarily determined by adherence to the selected intervention. The most common treatment pathways are mechanical devices such as continuous positive airway pressure (CPAP) or a mandibular advancement device, often combined with weight loss therapy. Weight reduction is usually an adjunct therapy but may be used as a secondary treatment in mild-to-moderate OSA when mechanical treatments cannot be tolerated. To enhance the uptake and adherence to treatment, clinicians may assess patient's personality profiles and psychological readiness. There is a paucity of evidence related to these aspects of patient care and this article outlines the current research in relation to patient presentation, treatment uptake and barriers, and methods to enhance treatment adherence.This article disseminates personality traits observed in patients with OSA and identifies vulnerable groups who may require additional support to increase treatment adherence. It summarises the current evidence for treatment barriers in patients with OSA. Low self-efficacy in relation to CPAP and weight loss adherence will be explored as well as the potential to predict treatment responders and enhance therapeutic uptake and adherence. Extending personality traits into research and clinical practice could potentially result in more successful CPAP therapy and weight loss treatment outcomes.
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27
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Zampogna E, Spanevello A, Lucioni AM, Facchetti C, Sotgiu G, Saderi L, Ambrosino N, Visca D. Adherence to Continuous Positive Airway Pressure in patients with Obstructive Sleep Apnoea. A ten year real life study. Respir Med 2019; 150:95-100. [PMID: 30961958 DOI: 10.1016/j.rmed.2019.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/07/2019] [Accepted: 02/17/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the predictive factors at 12 month and 10 year adherence to Continuous Positive Airway Pressure (CPAP) in patients with Obstructive Sleep Apnoea (OSA). METHODS Retrospective data analysis of patients starting CPAP between 2006 and 2009. After 12 months (T1) from start and during a 10 year follow up the following data were recorded: Body Mass Index (BMI), Time of night use, Epworth Sleepiness Scale (ESS) score. RESULTS Out of 315 patients, 147 fulfilled inclusion criteria and were evaluated. According to CPAP nighttime use during the first year, patients were divided into two groups: those using the device less < 4.5 h (Poor Adherence (PA): 61 patients), and those using ≥4.5 h: (Good Adherence (GA): 86 patients). Patients of PA group were significantly younger, had greater BMI and required more unscheduled visits during the first year. After 12 months, there were 11 (7.5%) dropouts, all in PA group. Patients using the nasal mask showed a greater prevalence among GA as compared to those using the oro-nasal mask (76.5% vs 57.8% respectively, p = 0.04). After 10 years 83 out of 147 (56.4%) patients were still under CPAP, 51 (59.3% of GA) and 32 (52.4% of PA group) respectively. Dropouts were significantly more frequent during the first 5 years (p = 0.04). CONCLUSION Ten years after prescription the majority of patients with OSA undergoing periodical controls, still perform CPAP independent of their adherence to therapy after one year of use. Use of nasal mask may be associate to better adherence.
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Affiliation(s)
- Elisabetta Zampogna
- Istituti Clinici Scientifici Maugeri IRCCS, U.O. di Pneumologia Riabilitativa di Tradate, via Roncaccio 16, Tradate, VA, Italy.
| | - Antonio Spanevello
- Istituti Clinici Scientifici Maugeri IRCCS, U.O. di Pneumologia Riabilitativa di Tradate, via Roncaccio 16, Tradate, VA, Italy; Università degli Studi dell'Insubria, Malattie dell'Apparato Respiratorio, Dipartimento di Medicina e Chirurgia, Varese, Italy.
| | - Anna Maria Lucioni
- Istituti Clinici Scientifici Maugeri IRCCS, U.O. di Pneumologia Riabilitativa di Tradate, via Roncaccio 16, Tradate, VA, Italy.
| | - Cristina Facchetti
- Istituti Clinici Scientifici Maugeri IRCCS, U.O. di Pneumologia Riabilitativa di Tradate, via Roncaccio 16, Tradate, VA, Italy.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Montescano, via di Montescano, PV, Italy.
| | - Dina Visca
- Istituti Clinici Scientifici Maugeri IRCCS, U.O. di Pneumologia Riabilitativa di Tradate, via Roncaccio 16, Tradate, VA, Italy.
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Seixas AA, Trinh-Shevrin C, Ravenell J, Ogedegbe G, Zizi F, Jean-Louis G. Culturally tailored, peer-based sleep health education and social support to increase obstructive sleep apnea assessment and treatment adherence among a community sample of blacks: study protocol for a randomized controlled trial. Trials 2018; 19:519. [PMID: 30249293 PMCID: PMC6154893 DOI: 10.1186/s13063-018-2835-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.
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Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, New York School of Medicine, New York, NY USA
- Department of Psychiatry, NYU Langone Health, New York, NY 10016 USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Joseph Ravenell
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Ferdinand Zizi
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Girardin Jean-Louis
- Department of Population Health, New York School of Medicine, New York, NY USA
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29
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Micoulaud-Franchi JA, Coste O, Bioulac S, Guichard K, Monteyrol PJ, Ghorayeb I, Weaver TE, Weibel S, Philip P. A French update on the Self-Efficacy Measure for Sleep Apnea (SEMSA) to assess continuous positive airway pressure (CPAP) use. Sleep Breath 2018; 23:217-226. [DOI: 10.1007/s11325-018-1686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 06/04/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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30
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May AM, Gharibeh T, Wang L, Hurley A, Walia H, Strohl KP, Mehra R. CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities. Chest 2018; 154:567-578. [PMID: 29684316 DOI: 10.1016/j.chest.2018.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/12/2018] [Accepted: 04/11/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Suboptimal CPAP adherence in OSA clinical trials involving predominantly white men limits interpretability and generalizability. We examined predictors of CPAP adherence in a clinical trial enriched with minorities. METHODS The Sleep Apnea Stress Study-a randomized, double-blind, sham-controlled trial of patients with moderate-to-severe OSA-included participants with complete 8-week adherence data (n = 138). Overnight 14-channel polysomnography, anthropometry, socioeconomic status, mood questionnaires, and week 1 CPAP adherence were analyzed via adjusted linear models relative to CPAP adherence (average minutes per night usage). RESULTS Overall, age was 51 ± 12 years, 55% of the patients were male, 55% were white, BMI was 36.7 ± 7.7 kg/m2, and median apnea-hypopnea index was 20 (interquartile range, 13-37). In univariate analyses adherence increased with randomization to active CPAP (81 min; 95% CI, 30-132), increasing age (35 min/decade; 95% CI, 13-57), white race (78 min, 95% CI, 26-129), and per hour of week 1 adherence (41 min, 95% CI, 32-51). Active CPAP (48 min, 95% CI, 6-91), increasing age (27 min/decade, 95% CI, 10-44), and higher 1-week adherence (36 min/h, 95% CI, 27-46) were significantly associated with improved adherence in multivariable analyses. Subgroup analyses showed stronger associations of adherence with treatment arm in whites and increasing age in minorities. Increasing age and white race were more strongly associated with adherence in women. CONCLUSIONS In this trial with near-even sex distribution and high ethnic minority representation, we identified CPAP assignment, increasing age, and early adherence to be associated with improved adherence in addition to sex-specific and race-specific adherence differences. These results can inform targeted clinical trial adherence optimization strategies. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00607893; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Anna M May
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.
| | - Tarek Gharibeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Ahuja Medical Center, Cleveland, OH
| | - Lu Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Amanda Hurley
- Indiana Wesleyan University School of Nursing, Marion, IN
| | - Harneet Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Sutherland K, Almeida FR, de Chazal P, Cistulli PA. Prediction in obstructive sleep apnoea: diagnosis, comorbidity risk, and treatment outcomes. Expert Rev Respir Med 2018; 12:293-307. [DOI: 10.1080/17476348.2018.1439743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Kate Sutherland
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | | | - Philip de Chazal
- Charles Perkins Centre, University of Sydney, Sydney, Australia
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Peter A. Cistulli
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
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Comorbid insomnia symptoms predict lower 6-month adherence to CPAP in US veterans with obstructive sleep apnea. Sleep Breath 2018; 22:5-15. [PMID: 29330768 DOI: 10.1007/s11325-017-1605-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/20/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE There is limited information on the association between pre-treatment insomnia symptoms and dysfunctional sleep beliefs with continuous positive airway pressure (CPAP) adherence in veterans with obstructive sleep apnea (OSA). Our aims were to describe demographic and sleep characteristics of veterans with and without comorbid insomnia and determine whether pre-treatment insomnia symptoms and dysfunctional sleep beliefs predict CPAP use after 6 months of therapy. METHODS Hispanic veterans attending the Miami VA sleep clinic were recruited and completed the insomnia severity index, the dysfunctional sleep belief and attitude scale (DBAS), and other questionnaires. Participants were asked to return after 7 days and 1 and 6 months to repeat questionnaires and for objective CPAP adherence download. Hierarchical regression models were performed to determine adjusted associations of pre-treatment insomnia symptoms and DBAS sub-scores on 6-month mean daily CPAP use. RESULTS Fifty-three participants completed the 6-month follow-up visit with a mean CPAP use of 3.4 ± 1.9 h. Veterans with comorbid insomnia had lower mean daily CPAP use (168 ± 125 vs 237 ± 108 min, p = 0.04) and lower percent daily CPAP use ≥ 4 h (32 ± 32 vs 51 ± 32%, p = 0.05) compared to participants without insomnia. In adjusted analyses, pre-treatment insomnia symptoms (early, late, and aggregated nocturnal symptoms) and sleep dissatisfaction were predictive of lower CPAP use at 6 months. Pre-treatment dysfunctional sleep beliefs were not associated with CPAP adherence. CONCLUSIONS Pre-treatment nocturnal insomnia symptoms and sleep dissatisfaction predicted poorer 6- month CPAP use. Insomnia treatment preceding or concurrent with CPAP initiation may eliminate a barrier to regular use.
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Luyster FS, Strollo PJ, Thunström E, Peker Y. Long-term use of continuous positive airway pressure therapy in coronary artery disease patients with nonsleepy obstructive sleep apnea. Clin Cardiol 2017; 40:1297-1302. [PMID: 29243273 DOI: 10.1002/clc.22827] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Excessive daytime sleepiness is a frequent symptom of obstructive sleep apnea (OSA) and has been proposed as a motivator for adherence to continuous positive airway pressure (CPAP) therapy. However, excessive daytime sleepiness is absent in many patients with coronary artery disease (CAD) and concomitant OSA. We evaluated long-term use of CPAP and predictors of CPAP use in nonsleepy and sleepy OSA patients from a CAD cohort. HYPOTHESIS Long-term CPAP use is lower in CAD patients with nonsleepy OSA vs sleepy OSA. METHODS Nonsleepy (Epworth Sleepiness Scale [ESS] score < 10) OSA patients randomized to CPAP (n = 122) and sleepy (ESS ≥10) OSA patients offered CPAP (n = 155) in the RICCADSA trial in Sweden were included in this substudy. The median follow-up was 4.8 years for the main trial, with a predefined minimum follow-up of 2 years. RESULTS The probability of remaining on CPAP at 2 years was 60% in nonsleepy patients and 77% in sleepy patients. Multivariate analyses indicated that age and hours of CPAP use per night at 1 month were independently associated with long-term CPAP use in nonsleepy patients. In the sleepy phenotype, body mass index, acute myocardial infarction at baseline, and hours of CPAP use per night at 1 month were predictors of long-term CPAP use. CONCLUSIONS Long-term use of CPAP is likely to be challenging for CAD patients with nonsleepy OSA. Early CPAP use is an important predictor of continued long-term use of CPAP, so optimizing patients' initial experience with CPAP could promote adherence.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - Yüksel Peker
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Xanthopoulos MS, Kim JY, Blechner M, Chang MY, Menello MK, Brown C, Matthews E, Weaver TE, Shults J, Marcus CL. Self-Efficacy and Short-Term Adherence to Continuous Positive Airway Pressure Treatment in Children. Sleep 2017; 40:3852151. [PMID: 28541508 DOI: 10.1093/sleep/zsx096] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Infants, children, and adolescents are increasingly being prescribed continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea syndrome (OSAS), yet adherence is often poor. The purpose of this study was to examine the relationship between caregiver and patient-reported health cognitions about CPAP prior to starting CPAP and CPAP adherence at 1 month. We hypothesized that greater caregiver-reported self-efficacy would be positively associated with CPAP adherence in children. We also evaluated patient-reported self-efficacy and caregiver- and patient-reported risk perception and outcome expectations as they related to adherence, as well as how demographic factors influenced these relationships. Methods A pediatric modification of the Self-Efficacy Measure for Sleep Apnea Questionnaire was administered to children and adolescents with OSAS-prescribed CPAP and their caregivers during the clinical CPAP-initiation visit. The primary outcome variable for adherence was the average total minutes of CPAP usage across all days from the date that CPAP was initiated to 31 days later. Results Unadjusted ordinary least-square regression showed a significant association between caregiver-reported self-efficacy and adherence (p = .007), indicating that mean daily CPAP usage increased by 48.4 minutes when caregiver-reported self-efficacy increased by one point (95% confidence interval 13.4-83.4 minutes). No other caregiver- or patient-reported cognitive health variables were related to CPAP use. Conclusions This study indicates that caregiver CPAP-specific self-efficacy is an important factor to consider when starting youth on CPAP therapy for OSAS. Employing strategies to improve caregiver self-efficacy, beginning at CPAP initiation, may promote CPAP adherence.
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Affiliation(s)
| | - Ji Young Kim
- Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Ming-Yu Chang
- Division of Pediatric General Medicine, Chang Gung Children's Hospital, Taoyuan, China
| | | | | | | | - Terri E Weaver
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Justine Shults
- Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Carole L Marcus
- Sleep Center.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
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Copur AS, Erik Everhart D, Zhang C, Chen Z, Shekhani H, Mathevosian S, Loveless J, Watson E, Kadri I, Wallace L, Simon E, Fulambarker AM. Effect of personality traits on adherence with positive airway pressure therapy in obstructive sleep apnea patients. Sleep Breath 2017; 22:369-376. [PMID: 28856525 DOI: 10.1007/s11325-017-1559-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/14/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Patient adherence with positive airway pressure (PAP) therapy is a significant clinical problem in obstructive sleep apnea treatment. Personality traits may be a factor for non-adherence. The aim of this study is to investigate the relationship between PAP therapy adherence and patient personality traits. METHODS Patients were screened and recruited during their visit to a sleep clinic. Baseline data were collected from each patient's electronic chart. Behavioral inhibition system/behavioral activation system (BIS/BAS) scales, short measure of five-factor model personality traits (mini-IPIP), positive and negative affect score (PANAS), and appetitive motivation scores (AMS) tests were used to measure personality traits. Data from the PAP device were obtained following a minimum of an initial 30 days, with adherence defined as >4 h/night on 70% of nights. Univariate and multivariate logistic regression and Pearson correlation tests were used to analyze the data. RESULTS A total of 400 patients were recruited. Three hundred twenty-one patients had all the data and were included in the study. Behavioral activation system-fun seeking (BAS-FS) and, to a certain extent, negative affect were significantly associated with adherence. Intellect/imagination was marginally significant. Additionally, older age (>65 years), profession, PAP type, side effects, efficiency, apnea-hypopnea index (AHI), and residual AHI showed significant associations with patient adherence with PAP therapy. Multivariate analysis revealed that BAS-FS was still a significant predictor of adherence even after adjusting for other covariates. CONCLUSION BAS-FS, negative affect, and intellect/imagination are significant factors for adherence to PAP therapy in obstructive sleep apnea patients.
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Affiliation(s)
- Ahmet Sinan Copur
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA. .,, 424 Park Lane, Lake Bluff,, Shields Township,, IL, 60044, USA.
| | | | - Chao Zhang
- Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Zhengjia Chen
- Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Haris Shekhani
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Sipan Mathevosian
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Eric Watson
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Imtiazali Kadri
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Leandra Wallace
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Edwin Simon
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ashok M Fulambarker
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Ward K, Gott M, Hoare K. Making choices about CPAP: Findings from a grounded theory study about living with CPAP. Collegian 2017. [DOI: 10.1016/j.colegn.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Haviv Y, Zini A, Almoznino G, Keshet N, Sharav Y, Aframian DJ. Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea. Oral Dis 2017; 23:629-635. [DOI: 10.1111/odi.12633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/26/2016] [Accepted: 12/26/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Y Haviv
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - A Zini
- Department of Community Dentistry; Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - G Almoznino
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial Center; Tel-Hashomer, Medical Corps; Israel Defence Forces; Jerusalem Israel
| | - N Keshet
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - Y Sharav
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - DJ Aframian
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
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Hostler JM, Sheikh KL, Andrada TF, Khramtsov A, Holley PR, Holley AB. A mobile, web-based system can improve positive airway pressure adherence. J Sleep Res 2016; 26:139-146. [DOI: 10.1111/jsr.12476] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jordanna M. Hostler
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
| | | | - Teotimo F. Andrada
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
| | - Andrei Khramtsov
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
| | - Paul R. Holley
- Department of Informatics; US Army Medical Research Institute of Infectious Diseases; Frederick MD USA
| | - Aaron B. Holley
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
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D’Rozario AL, Galgut Y, Bartlett DJ. An Update on Behavioural Interventions for Improving Adherence with Continuous Positive Airway Pressure in Adults. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0051-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Yaggi HK, Mittleman MA, Bravata DM, Concato J, Ware J, Stoney CM, Redline S. Reducing cardiovascular risk through treatment of obstructive sleep apnea: 2 methodological approaches. Am Heart J 2016; 172:135-43. [PMID: 26856225 DOI: 10.1016/j.ahj.2015.07.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 07/02/2015] [Indexed: 11/19/2022]
Abstract
Obstructive sleep apnea (OSA) significantly impacts cardiovascular health, demonstrated by observational investigations showing an independently increased risk of ischemic heart disease, diabetes, hypertension, congestive heart failure, acute coronary syndrome, stroke, cardiovascular mortality, and all-cause mortality. Positive airway pressure (PAP), a medical therapy for sleep apnea, reverses airway obstruction and may help reduce cardiovascular risk. Prior to planning large phase III randomized controlled trials to test the impact of PAP on cardiovascular outcomes, several gaps in knowledge need to be addressed. This article describes 2 independent studies that worked collaboratively to fill these gaps. The populations, design features, and relative benefits/challenges of the 2 studies (SleepTight and BestAIR) are described. Both studies were encouraged to have multidisciplinary teams with expertise in behavioral interventions to improve PAP compliance. Both studies provide key information that will be useful to the research community in future large-scale, event-driven, randomized trials to evaluate the efficacy and/or effectiveness of strategies to identify and treat significant OSA for decreasing risk of major adverse cardiovascular events in high-risk patients.
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Affiliation(s)
- Henry Klar Yaggi
- Department of Medicine, Yale School of Medicine, New Haven, CT; VA Clinical Epidemiology Research Center, VA Connecticut HCS, West Haven, CT.
| | - Murray A Mittleman
- Department of Medicine, Beth Israel Deaconess, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Dawn M Bravata
- VA Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Medicine, Indiana School of Medicine, Indianapolis, IN; Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
| | - John Concato
- Department of Medicine, Yale School of Medicine, New Haven, CT; VA Clinical Epidemiology Research Center, VA Connecticut HCS, West Haven, CT
| | - James Ware
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | | | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, MA; Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Sedkaoui K, Leseux L, Pontier S, Rossin N, Leophonte P, Fraysse JL, Didier A. Efficiency of a phone coaching program on adherence to continuous positive airway pressure in sleep apnea hypopnea syndrome: a randomized trial. BMC Pulm Med 2015; 15:102. [PMID: 26370444 PMCID: PMC4570038 DOI: 10.1186/s12890-015-0099-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 09/08/2015] [Indexed: 11/21/2022] Open
Abstract
Background Continuous Positive Airway Pressure (CPAP) remains the reference treatment for moderate to severe forms of the Sleep Apnea/Hypopnea Syndrome (SAHS). Compliance to the treatment appears to be a key factor to improving health status of these patients. Methods We conducted a multicenter, prospective, randomized, controlled, parallel group trial of standard support completed or not within 3 months of coaching sessions for newly diagnosed SAHS patients starting CPAP therapy. This study has been recorded by AFSSAPS with the RCB number: 2009-A01127-50 and received favourably by the Human Studies Committee in France. The coaching session consisted of 5 sessions of telephone-based counselling by competent staff. The primary outcome was the proportion of patients using CPAP more than 3 h per night for 4 months; the secondary outcome was mean hours of CPAP usage in the 2 groups. Results Three hundred and seventy-nine patients fulfilled the inclusion criteria and were randomized. The percentage of patients using CPAP more than 3 h per night for 4 months was 65 % for the standard support group and 75 % for the coached group. This difference reached a statistical significance (χ2 = 3.97). The mean CPAP usage was increased in the coached group versus standard group. A difference of 26 min was observed (4 h34+/−2 h17 and 4 h08+/−2 h25 respectively, p = 0.04). Conclusion This study shows that SAHS patients who benefit from phone coaching are statistically more compliant to CPAP than a standard support group is. A simple phone coaching procedure based on knowledge of the disease and reinforcement messages about treatment benefits helps to improve CPAP adherence in SAHS patients. Trial registration NCT02435355
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Affiliation(s)
- Kamila Sedkaoui
- Service de pneumologie - allergologie, hôpital Larrey, CHU de Toulouse, chemin de Pouvourville, 31059, Toulouse, France.
| | - Ludivine Leseux
- SADIR association, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Sandrine Pontier
- Service de pneumologie - allergologie, hôpital Larrey, CHU de Toulouse, chemin de Pouvourville, 31059, Toulouse, France.
| | - Nicole Rossin
- SADIR assistance, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Paul Leophonte
- SADIR association, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Jean-Louis Fraysse
- SADIR assistance, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Alain Didier
- Service de pneumologie - allergologie, hôpital Larrey, CHU de Toulouse, chemin de Pouvourville, 31059, Toulouse, France.
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Attempters, adherers, and non-adherers: Latent profile analysis of CPAP use with correlates. Sleep Med 2015; 16:336-42. [DOI: 10.1016/j.sleep.2014.08.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 07/30/2014] [Accepted: 08/29/2014] [Indexed: 11/23/2022]
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Lai AYK, Fong DYT, Lam JCM, Weaver TE, Ip MSM. The efficacy of a brief motivational enhancement education program on CPAP adherence in OSA: a randomized controlled trial. Chest 2015; 146:600-610. [PMID: 24810282 DOI: 10.1378/chest.13-2228] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Poor adherence to CPAP treatment in OSA adversely affects the effectiveness of this therapy. This randomized controlled trial (RCT) examined the efficacy of a brief motivational enhancement education program in improving adherence to CPAP treatment in subjects with OSA. METHODS Subjects with newly diagnosed OSA were recruited into this RCT. The control group received usual advice on the importance of CPAP therapy and its care. The intervention group received usual care plus a brief motivational enhancement education program directed at enhancing the subjects' knowledge, motivation, and self-efficacy to use CPAP through the use of a 25-min video, a 20-min patient-centered interview, and a 10-min telephone follow-up. Self-reported daytime sleepiness adherence-related cognitions and quality of life were assessed at 1 month and 3 months. CPAP usage data were downloaded at the completion of this 3-month study. RESULTS One hundred subjects with OSA (mean ± SD, age 52 ± 10 years; Epworth Sleepiness Scales [ESS], 9 ± 5; median [interquartile range] apnea-hypopnea index, 29 [20, 53] events/h) prescribed CPAP treatment were recruited. The intervention group had better CPAP use (higher daily CPAP usage by 2 h/d [Cohen d = 1.33, P < .001], a fourfold increase in the number using CPAP for ≥ 70% of days with ≥ 4 h/d [P < .001]), and greater improvements in daytime sleepiness (ESS) by 2.2 units (P = .001) and treatment self-efficacy by 0.2 units (P = .012) compared with the control group. CONCLUSIONS Subjects with OSA who received motivational enhancement education in addition to usual care were more likely to show better adherence to CPAP treatment, with greater improvements in treatment self-efficacy and daytime sleepiness. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01173406; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Agnes Y K Lai
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China; Queen Mary Hospital, School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
| | - Daniel Y T Fong
- Queen Mary Hospital, School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
| | - Jamie C M Lam
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Terri E Weaver
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Mary S M Ip
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China; Research Centre of Heart, Brain, Hormone, and Healthy Aging, The University of Hong Kong, Hong Kong, SAR, China.
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Babbin SF, Velicer WF, Aloia MS, Kushida CA. Identifying Longitudinal Patterns for Individuals and Subgroups: An Example with Adherence to Treatment for Obstructive Sleep Apnea. MULTIVARIATE BEHAVIORAL RESEARCH 2015; 50:91-108. [PMID: 26609745 DOI: 10.1080/00273171.2014.958211] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
To improve complex behaviors such as adherence to medical recommendations, a better understanding of behavior change over time is needed. The focus of this study was adherence to treatment for obstructive sleep apnea (OSA). Adherence to the most common treatment for OSA is poor. This study involved a sample of 161 participants, each with approximately 180 nights of data. First, a time series analysis was performed for each individual. Time series parameters included the mean (average hours of use per night), level, slope, variance, and autocorrelation. Second, a dynamic cluster analysis was performed to find homogenous subgroups of individuals with similar adherence patterns. A four-cluster solution was found, and the subgroups were labeled: Great Users (17.2%; high mean and level, no slope), Good Users (32.8%; moderate mean and level, no slope), Low Users (22.7%; low mean and level, negative slope), and Slow Decliners (moderate mean and level, negative slope, high variance). Third, participants in the identified subgroups were compared to establish external validity. These steps represent a Typology of Temporal Patterns (TTP) approach. Combining time series analysis and dynamic cluster analysis is a useful way to evaluate longitudinal patterns at both the individual level and subgroup level.
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Affiliation(s)
- Steven F Babbin
- a Department of Psychology, Geisel School of Medicine at Dartmouth
| | - Wayne F Velicer
- b Cancer Prevention Research Center , University of Rhode Island
| | - Mark S Aloia
- c National Jewish Health and Philips/Respironics, Inc
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A basic intervention improves CPAP adherence in sleep apnoea patients: a controlled trial. Sleep Breath 2014; 19:509-14. [DOI: 10.1007/s11325-014-1038-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 06/03/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Ye L, Malhotra A, Kayser K, Willis DG, Horowitz JA, Aloia MS, Weaver TE. Spousal involvement and CPAP adherence: a dyadic perspective. Sleep Med Rev 2014; 19:67-74. [PMID: 24906222 DOI: 10.1016/j.smrv.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 03/21/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
Abstract
Poor adherence to continuous positive airway pressure (CPAP) treatment is associated with substantial health care costs, morbidity and mortality, and has been a leading obstacle in the effective management of obstructive sleep apnea (OSA). Successful interventions to improve CPAP adherence may ultimately include a variety of components. For patients living with spouses (refers to all domestic partners), the spouse will likely be an integral component to any successful intervention. Developing understanding of the role of spouses in adherence to CPAP has been identified to be a critical research need. This review expands the investigation of CPAP adherence to a broader context, from an exclusive focus on individual patients to a dyadic perspective encompassing both patients and their spouses. A conceptual framework based on social support and social control theories is proposed to understand spousal involvement in CPAP adherence. Methodologies for future investigations are discussed, along with implications for developing interventions that engage both patients and their spouses to improve CPAP use.
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Affiliation(s)
- Lichuan Ye
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA.
| | - Atul Malhotra
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Karen Kayser
- University of Louisville Kent School of Social Work, Louisville, KY, USA
| | - Danny G Willis
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - June A Horowitz
- Thomas Jefferson University School of Nursing, Philadelphia, PA, USA
| | | | - Terri E Weaver
- University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
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Lo Bue A, Salvaggio A, Isidoro SI, Romano S, Marrone O, Insalaco G. Usefulness of reinforcing interventions on continuous positive airway pressure compliance. BMC Pulm Med 2014; 14:78. [PMID: 24885065 PMCID: PMC4016649 DOI: 10.1186/1471-2466-14-78] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/24/2014] [Indexed: 12/02/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a high prevalence sleep disorder characterized by upper airway obstruction during sleep, nocturnal intermittent hypoxemia, poor sleep quality, risk for cardiovascular and metabolic diseases. The adherence to CPAP is the key for an effective management of these patients. The aim of the study was to assess the adherence to CPAP therapy with and without early reinforcing interventions, consisting of motivational reinforcement and technical support in the first month of therapy. Methods Forty patients with OSA undergoing counseling and a one year follow-up on a quarterly basis were included in the study. Twenty subjects (intervention group) underwent reinforcing interventions with telephone interviews in the first month of therapy, and twenty (control group) remained without reinforcing interventions. The two populations were homogeneous for age, severity of illness and BMI. Results During the first month, intervention group patients showed a higher number of nights with a device use ≥4 hours. Average treatment adherence in the first month (days of therapy with at least 4 hours per night on the total number of days from device delivery) was 77.5% in the intervention group and 55.7% in the control group (p = 0.022). At one year the differences between the two groups were not significant. Conclusions Our findings suggest that it is important that adequate time and effort is spent to ensure patient comfort at the time of CPAP therapy start to optimize acceptance and adherence to treatment, and suggest that it is necessary to maintain reinforcing interventions over time.
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Affiliation(s)
| | - Adriana Salvaggio
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A, Monroy", Via Ugo La Malfa, 153, 90146 Palermo, Italy.
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Crawford MR, Espie CA, Bartlett DJ, Grunstein RR. Integrating psychology and medicine in CPAP adherence – New concepts? Sleep Med Rev 2014; 18:123-39. [DOI: 10.1016/j.smrv.2013.03.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 12/11/2022]
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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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Aloia MS, Arnedt JT, Strand M, Millman RP, Borrelli B. Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 2013; 36:1655-62. [PMID: 24179298 DOI: 10.5665/sleep.3120] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a variety of medical conditions. Positive airway pressure (PAP) is an effective treatment for improving sleep, yet adherence rates are low. The aim of the current study is to test two treatments versus standard care in improving adherence to PAP. METHOD Two hundred twenty-seven patients with OSA were randomized to standard care (SC), education (ED) and motivational enhancement therapy (MET). Adherence was measured objectively and the first week of adherence (prior to the intervention) was used as an a priori moderator of the effect of the various interventions. Mediators of treatment response were also examined using theory-based measures of decisional balance and self-efficacy. RESULTS Adherence declined over time for all three groups. There was a significant interaction between level of adherence during the first week of treatment and treatment group. Those who had moderate levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had MET; those who had high levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had ED. MET treatment increased the perception of the positive aspects of PAP, but ED did not. CONCLUSIONS Initial adherence to positive airway pressure could help guide subsequent treatment plans. The results also support social cognitive theory in that educational approaches might be best suited for those who are ready for change whereas more motivational approaches might be best for those who are ambivalent about change.
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Affiliation(s)
- Mark S Aloia
- Department of Medicine, National Jewish Health, Denver, CO
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