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Petrov ME, Epstein DR, Krahn L, Todd M, Park JG, St. Louis EK, Morgenthaler TI, Hoffmann CM, Hasanaj K, Hollingshead K, Yu TY, Buman MP. SleepWell24, a Smartphone Application to Promote Adherence to Positive Airway Pressure Therapy: Feasibility and Acceptability in a Randomized Controlled Trial. Behav Sleep Med 2024; 22:420-432. [PMID: 38032115 PMCID: PMC11136882 DOI: 10.1080/15402002.2023.2289442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To investigate the feasibility and acceptability of SleepWell24, a multicomponent, evidence-based smartphone application, to improve positive airway pressure therapy (PAP) adherence, among patients with obstructive sleep apnea (OSA) naive to PAP. METHODS In a single-blind randomized controlled trial, SleepWell24, with a companion activity monitor was compared to usual care plus the activity monitor and its associated app. SleepWell24 provides objective feedback on PAP usage and sleep/physical activity patterns, and chronic disease management. Patients were recruited from two sleep medicine centers and followed over the first 60 days of PAP. Feasibility and acceptability were measured by recruitment/retention rates, app usage, differences in post-trial Treatment Evaluation Questionnaire (TEQ) scores, and patient interviews. Exploratory, intent-to-treat logistic and linear mixed models estimated PAP adherence and clinical outcomes. RESULTS Of 103 eligible participants, 87 were enrolled (SleepWell24 n = 40, control n = 47; mean 57.6y [SD = 12.3], 44.8% female). Retention was ≥95% across arms. There were no significant differences in TEQ scores. SleepWell24 participants engaged with the app on 62.9% of trial days. PAP use was high across both arms (SleepWell24 vs. Control: mean hours 5.98 vs. 5.86). There were no differences in PAP adherence or clinical outcomes. CONCLUSIONS SleepWell24 was feasible and acceptable among PAP-naive patients with OSA. CLINICAL TRIAL REGISTRATION NCT03156283https://www.clinicaltrials.gov/study/NCT03156283.
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Affiliation(s)
- Megan E. Petrov
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3 Street Suite 301, Phoenix, AZ 85004
| | - Dana R. Epstein
- College of Health Solutions, Edson College of Nursing and Health Innovation, Arizona State University
| | - Lois Krahn
- Center for Sleep Medicine, Department of Pulmonary Medicine, Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, Arizona
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University
| | - John G. Park
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Erik K. St. Louis
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin
| | - Timothy I. Morgenthaler
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Coles M. Hoffmann
- Edson College of Nursing and Health Innovation, Arizona State University
| | | | | | - Tsung-Yen Yu
- College of Health Solutions, Arizona State University
| | - Matthew P. Buman
- College of Health Solutions, Arizona State University, 550 N. 3 Street Suite 501, Phoenix, AZ 85004
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Thong BKS, Loh GXY, Lim JJ, Lee CJL, Ting SN, Li HP, Li QY. Telehealth Technology Application in Enhancing Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea Patients: A Review of Current Evidence. Front Med (Lausanne) 2022; 9:877765. [PMID: 35592853 PMCID: PMC9110793 DOI: 10.3389/fmed.2022.877765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common type of sleep-disordered breathing associated with multiple comorbidities. Continuous positive airway pressure (CPAP) is the first choice for moderate-severe OSA but poor compliance brings a great challenge to its effectiveness. Telehealth interventions ease the follow-up process and allow healthcare facilities to provide consistent care. Fifth-generation wireless transmission technology has also greatly rationalized the wide use of telemedicine. Herein, we review the efficacy of the telehealth system in enhancing CPAP adherence. We recommend applying telemonitoring in clinical practice and advocate the development of a biopsychosocial telemedicine model with the integration of several interventions. Big databases and promising artificial intelligent technologies make clinical decision support systems and predictive models based on these databases possible.
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Affiliation(s)
- Benjamin Ka Seng Thong
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Grace Xin Yun Loh
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jan Lim
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Christina Jia Liang Lee
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu Ning Ting
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Peng Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Stanchina M, Lincoln J, Prenda S, Holt M, Leon I, Donat W, Corrao W, Jabbour E, Koenig S, Malhotra A. The impact of different CPAP delivery approaches on nightly adherence and discontinuation rate in patients with obstructive sleep apnea. J Clin Sleep Med 2022; 18:2023-2027. [PMID: 35499279 PMCID: PMC9340606 DOI: 10.5664/jcsm.10038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The impact of direct mail order sales of positive airway pressure (PAP) devices, accentuated by the coronavirus disease 2019 (COVID-19) pandemic, on PAP adherence in patients with obstructive sleep apnea remains unclear. In this study we compared the impact of different modes of continuous positive airway pressure delivery on adherence and daytime symptoms. We hypothesized that adherence would not be affected by remote PAP setup, aided by telehealth technology. METHODS Three groups were studied: 1) standard group PAP setup (3-4 people); 2) direct home shipment of PAP, followed by telehealth interactions; 3) direct home shipment of PAP, during the COVID-19 pandemic where delivery choice was removed. Demographics, sleepiness, PAP data, and insurance information were also compared. RESULTS A total of 666 patients were studied in 3 groups. 1) Standard group PAP setup had 225 patients and adherence with PAP (% of nights used more than 4 hours) was 65.3 ± 2.1%. 2) Direct home shipment of PAP group had 231 patients, and adherence was 54.2 ± 2.4%. 3) Direct mailed PAP units during the COVID-19 pandemic group had 210 patients, and adherence was 55.9 ± 2.5%. Adherence was lower in both groups receiving home shipments compared to those in groups in-center (analysis of variance, Tukey, P = .002). Discontinuation of PAP was less in the in-center group setup patients (χ2 = 10.938 P ≤ .001). CONCLUSIONS Patients receiving direct home PAP shipments had lower adherence and were more likely to discontinue PAP compared to standard in-person setup. CITATION Stanchina M, Lincoln J, Prenda S, et al. The impact of different CPAP delivery approaches on nightly adherence and discontinuation rate in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(8):2023-2027.
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Affiliation(s)
- Michael Stanchina
- Brigham and Women’s Pulmonary at CNE, East Greenwich, RI
- Kent Hospital, East Greenwich, RI
- Alpert School of Medicine at Brown University
- Epoch Sleep Centers, Providence, RI
| | | | | | - Molly Holt
- Brigham and Women’s Pulmonary at CNE, East Greenwich, RI
| | - Ingrid Leon
- Brigham and Women’s Pulmonary at CNE, East Greenwich, RI
| | - Walter Donat
- Brigham and Women’s Pulmonary at CNE, East Greenwich, RI
- Kent Hospital, East Greenwich, RI
| | - William Corrao
- Brigham and Women’s Pulmonary at CNE, East Greenwich, RI
- Kent Hospital, East Greenwich, RI
- Alpert School of Medicine at Brown University
| | - Elias Jabbour
- Brigham and Women’s Pulmonary at CNE, East Greenwich, RI
- Kent Hospital, East Greenwich, RI
| | | | - Atul Malhotra
- Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA
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Tran K, Wang L, Mehra R, Vanek R, Kaw S, Campean T, Foldvary-Schaefer N, Moul DE, Walia H. Impact of the sleep apnea management group clinic on positive airway pressure adherence. Sleep Breath 2021; 26:189-194. [PMID: 33928484 PMCID: PMC8084412 DOI: 10.1007/s11325-021-02352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Abstract
Background Positive airway pressure (PAP) adherence is critical for managing obstructive sleep apnea (OSA). We postulate that group-based Sleep Apnea Management (SAM) clinic, which harnesses the benefits of providing mutual support as well as facilitates access to system-based resources and education, will confer improvements in PAP adherence. Methods Data from SAM clinic attendees from January 2017 to June 2018 were retrospectively analyzed. Adherence data at SAM baseline visit and 1-3 months follow-up were collected. Average PAP usage from all-days and days used were analyzed along with demographics, co-morbidities, and Epworth Sleepiness Scale. Adherence was defined as >4 hours a night for ≥70% of nights over a 30-day period. Key structural elements of the SAM group clinic model were co-presence of the OSA care team members and peer group support. Key efficiency elements were group education and the prompt-to-patient multidisciplinary troubleshooting adherence barriers. Results Of 110 SAM clinic attendees, average age was 60.9±12.7 years, 53% were men, and 46% Caucasian. At baseline, the mean for average-all-days usage was 4.2 hours, mean average-days-used usage was 5.2 hours, and mean percentage-of-days usage ≥4 hours was 57%. At follow-up, the mean average-all-days usage increased 1.2 hours (p<0.001), mean average-days-used usage increased 0.8 hours (p<0.001), and the mean percentage-of-days with usage ≥4 hours increased 16% (p<0.001). At baseline, 46% of patients met criteria for adherence, which increased to 66% at follow-up. Conclusion In this study, after the SAM clinic, all PAP adherence parameters improved significantly. This observational study serves as a proof of concept study for future trials pertaining to group clinic in managing PAP adherence in OSA.
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Affiliation(s)
- Katie Tran
- Center for Sleep and Breathing Disorders, UT Southwestern University, Dallas, TX, USA
| | - Lu Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robon Vanek
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shivani Kaw
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tina Campean
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Douglas E Moul
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Harneet Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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Tejedor M, Alcalde D, Cruces C, Hernando E, López-Martín MC, Briz R, Calvache A, Barranco R, Castillo LA, Chico I, de Lucas M, Marrufo Ramos R, Rodríguez R, Delgado M. Functional gastrointestinal disorders: real-life results of a multidisciplinary non-pharmacological approach based on group-consultations. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:627-634. [PMID: 33371689 DOI: 10.17235/reed.2020.7276/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION functional gastrointestinal disorders are prevalent and resource consuming. The use of group-consultations in these diseases is limited and no specific multidisciplinary programs have been developed. METHODS a multidisciplinary approach was used in patients with diverse functional gastrointestinal disorders attending group-consultations (group A). Five two-hour sessions were scheduled over a four-month period. Sessions consisted of a theoretical introduction (Pathophysiology, Low fodmap diet, Over the counter medications, Mediterranean diet, and Laughter therapy workshop) followed by relaxation techniques. This group was compared to a similar group of patients who received written information covering the topics discussed during the group-consultations (group B). Severity of digestive and psychological symptoms, use of drugs and adherence to the diet were the main outcomes measured. RESULTS the mean age of participants was 43 (± 1.38) years, 78 % were female and 73 % had at least two functional gastrointestinal disorders. Sixty-two patients were included in group A and 17 in group B. The severity of gastrointestinal and psychological symptoms at baseline was similar in both groups. Globally, there was an improvement in all symptoms in both groups. The proportion of participants with severe baseline gastrointestinal symptoms or pathologic anxiety scores that showed improvement was significantly higher in group A (74 % vs 23 %, p = 0.005; 47 % vs 8 %, p = 0.02, respectively). Symptoms were reassessed at six and 12 months after the intervention in participants from group A who attended ≥ 80 % sessions and a sustained response was observed. CONCLUSIONS group-consultations are useful and efficient to alleviate gastrointestinal and psychological symptoms in patients with functional gastrointestinal disorders.
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Affiliation(s)
- Marta Tejedor
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | - Daniel Alcalde
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | - Cristina Cruces
- Endocrinology and Nutrition, Hospital Universitario Infanta Elena, España
| | - Elena Hernando
- Psychiatry, Hospital Universitario Infanta Elena, España
| | | | - Rosa Briz
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | - Almudena Calvache
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | - Raquel Barranco
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | | | - Inmaculada Chico
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | - María de Lucas
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | | | - Raquel Rodríguez
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena, España
| | - María Delgado
- Gastroenterology and Hepatology, Hospital Universitario Infanta Elena
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Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. Sleep Med Clin 2020; 15:227-240. [PMID: 32386697 DOI: 10.1016/j.jsmc.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.
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7
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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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8
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Bakker JP, Weaver TE, Parthasarathy S, Aloia MS. Adherence to CPAP. Chest 2019; 155:1272-1287. [DOI: 10.1016/j.chest.2019.01.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 01/17/2023] Open
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9
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Predictors of CPAP adherence following stroke and transient ischemic attack. Sleep Med 2018; 66:243-249. [PMID: 30522873 DOI: 10.1016/j.sleep.2018.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Continuous positive airway pressure (CPAP) has been shown to improve functional, motor and cognitive outcomes in post-stroke obstructive sleep apnea (OSA). However, rates of CPAP adherence are often low and factors impacting CPAP adherence remain under-explored. Our objective was to determine predictors of CPAP adherence in patients who had a stroke or transient ischemic attack (TIA). METHODS We screened 313 stroke/TIA patients for OSA using in-hospital polysomnography or the ApneaLink home sleep apnea test. Potential predictors were recorded at baseline and adherence to CPAP was recorded during a six-month follow-up visit. Selected variables from our univariate analyses were included in multivariate regression models to determine predictors of CPAP adherence. For our logistic regression analyses, CPAP adherence (CPAP use of ≥4 h per night) was the dependent outcome variable. In our linear regression analyses, total CPAP use per week (recorded in hours) was the dependent outcome variable. RESULTS Eighty-eight patients (mean age 67.81 ± 13.09 years, 69.32% male, mean body mass index 27.93 ± 5.23 kg/m2) were diagnosed with OSA, prescribed CPAP, and assessed for adherence at a six-month follow-up visit. In these 88 patients, 46 (52.27%) were adherent with CPAP therapy. From our regression models, two significant predictors of CPAP adherence were identified: greater functional status (p = 0.04) and not endorsing daytime tiredness (p = 0.047) post-stroke/TIA. CONCLUSION Patients with greater functional capacity and those with less daytime fatigue demonstrated stronger adherence to CPAP therapy. Our findings may facilitate future treatment strategies for enhancing CPAP adherence in the vulnerable stroke/TIA population.
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Toraldo DM, Passali D, Sanna A, De Nuccio F, Conte L, De Benedetto M. Cost-effectiveness strategies in OSAS management: a short review. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:447-453. [PMID: 28663598 PMCID: PMC5782420 DOI: 10.14639/0392-100x-1520] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/11/2017] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnoea (OSAS) is an underdiagnosed chronic disease with a high prevalence in adults. It is becoming a significant social problem, since it is associated with a worsening in quality of life and increase in mortality. The cost-effectiveness ratio of diagnostic and therapeutic management of OSAS is a strategic issue to counteract the expected increasing demand of objective testing. OSAS patients with any clinical evidence of comorbidities must be studied using simplified and less expensive systems such as Home Sleep Testing (HST). On the other hand, Sleep Laboratory Polysomnography (PSG) is the gold standard to manage OSAS patients with comorbidities. It should be pointed out that the use of HST can lead to incorrect diagnosis in poorly selected OSAS subjects. This short review discusses various topics for the proper diagnosis and treatment of OSAS in view of epidemiological factors and results in terms of costs and social benefit of the disease. Whatever the strategy chosen and/or the organisational model adopted for managing OSAS, it cannot and should not take into account only cost-effectiveness. Long-term prospective studies evaluating cost-effectiveness ratios and outcomes of OSAS treatment of hospital management models versus home care models are needed.
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Affiliation(s)
- D M Toraldo
- Hospital Rehabilitation, Dept Cardio-Respiratory Care Unit, "V Fazzi", ASL Lecce, Italy
| | - D Passali
- ENT Clinic, University of Siena, Italy
| | - A Sanna
- Pneumology Unit, San Jacopo Hospital, Azienda USL Toscana Centro, Pistoia, Italy
| | - F De Nuccio
- Laboratory of Human Anatomy and Neuroscience, Dept. of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - L Conte
- Laboratory of Interdisciplinary Research Applied to Medicine (DReAM), University of Salento at the Hospital "V Fazzi", ASL Lecce, Italy
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Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. Sleep Med Clin 2017; 12:551-564. [PMID: 29108610 DOI: 10.1016/j.jsmc.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.
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12
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Collop N, Stierer TL, Shafazand S. SAVE Me From CPAP. J Clin Sleep Med 2016; 12:1701-1704. [PMID: 27855746 DOI: 10.5664/jcsm.6366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 11/13/2022]
Affiliation(s)
- Nancy Collop
- Emory Sleep Center, Emory University, Atlanta, GA
| | - Tracy L Stierer
- Johns Hopkins Center for Sleep at Howard County General Hospital, Johns Hopkins University, Baltimore, MD
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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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Kitamura T, Miyazaki S, Koizumi H, Takeuchi S, Tabata T, Suzuki H. Sleep hygiene education for patients with obstructive sleep apnea. Sleep Biol Rhythms 2015. [DOI: 10.1007/s41105-015-0015-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Masa JF, Corral-Peñafiel J. Should use of 4 hours continuous positive airway pressure per night be considered acceptable compliance? Eur Respir J 2014; 44:1119-20. [DOI: 10.1183/09031936.00121514] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Bouloukaki I, Giannadaki K, Mermigkis C, Tzanakis N, Mauroudi E, Moniaki V, Michelakis S, Siafakas NM, Schiza SE. Intensive versus standard follow-up to improve continuous positive airway pressure compliance. Eur Respir J 2014; 44:1262-74. [PMID: 24993911 DOI: 10.1183/09031936.00021314] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We aimed to compare the effect of intensive versus standard interventions on continuous positive airway pressure (CPAP) adherence 2 years after CPAP initiation, as well as on sleepiness, quality of life, depression, hospitalisation and death rate due to cardiovascular disease (CVD). 3100 patients with newly diagnosed sleep apnoea were randomised into the standard group, with usual follow-up care, or the intensive group, with additional visits, telephone calls and education. Subjective daytime sleepiness (Epworth Sleepiness Scale; ESS), quality of life (36-item Short Form Health Survey; SF-36) and the patient's level of depression (Beck Depression Inventory; BDI) were recorded before and 2 years after CPAP initiation, together with CVD hospitalisations and death rate. 2 years after CPAP initiation, the intensive group used CPAP significantly more than the standard group (6.9 versus 5.2 h per night; p<0.001). ESS, SF-36 and BDI scores were also significantly better in the intensive group. Furthermore, the standard group had significantly more deaths and hospitalisations due to CVD. CPAP usage can be improved by both intensive and standard patient support. However, the patients who received intensive CPAP support had significantly better ESS, BDI and SF-36 scores, and lower cardiovascular morbidity and mortality, suggesting that an intensive programme could be worthwhile.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Katerina Giannadaki
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Charalampos Mermigkis
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos Tzanakis
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Stylianos Michelakis
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos M Siafakas
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
| | - Sophia E Schiza
- Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece
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Affiliation(s)
- Terri E Weaver
- University of Illinois at Chicago College of Nursing, 845 South Damen Ave., Chicago, IL 60612, USA.
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