Can Intensive Support Improve Continuous Positive Airway Pressure Use in Patients with the Sleep Apnea/Hypopnea Syndrome?

Sleep Center, Royal Infirmary, Edinburgh, United Kingdom.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 04/1999; 159(4 Pt 1):1096-100. DOI: 10.1164/ajrccm.159.4.9808008
Source: PubMed


Continuous positive airway pressure (CPAP) therapy is widely prescribed for patients with the sleep apnea/hypopnea syndrome (SAHS), but the use of CPAP for such patients is disappointingly low. We postulated that providing intensive educational programs and nursing support to SAHS patients might improve CPAP use and outcomes. We also examined the hypothesis that CPAP use would be greater among patients who had initiated their own referral than among those asked to seek help by a partner. We randomized 80 consecutive, new patients with SAHS to receive either usual support or additional nursing input including CPAP education at home and involving their partners, a 3-night trial of CPAP in our institution's sleep center, and additional home visits once they had begun CPAP. The primary outcome variable was objective CPAP use; symptoms, mood, and cognitive function were also assessed after 6 mo. CPAP use over 6 mo was greater (p = 0.003) among patients receiving intensive than among those receiving standard support (5.4 +/- 0.3 versus 3.9 +/- 0. 4 h/night [mean +/- SEM]), with greater improvements (p < 0.05) in SAHS symptoms, mood, and reaction time in the intensively supported group. CPAP use was greater (p = 0.002) among patients who initiated their own referrals. CPAP use and outcomes of therapy can be improved by provision of a nurse-led intensive CPAP education and support program. CPAP use is lower among patients whose partners ask them to seek treatment.

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    • "Lack of knowledge about OSA and CPAP has been identified by partners as negatively impacting their support for their partner's CPAP treatment, thus emphasizing the importance of providing partners with information during the initiation process (Elfström et al., 2012). Hoy et al. (1999) and Richards and colleagues (Richards, Bartlett, Wong, Malouff, & Grunstein, 2007) permitted partner attendance in their interventions; however, an important opportunity may have been missed for utilizing this shared experience. Our study findings support a developmental-contextual model of coping for understanding how couples together appraise and cope with a chronic illness (Berg & Upchurch, 2007). "
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    ABSTRACT: Few studies have investigated factors associated with continuous positive airway pressure (CPAP) treatment for sleep apnea from the patients' and their partners' perspective. This qualitative research study explored patients' and partners' experiences of CPAP and facilitators and barriers to CPAP use, and elicited suggestions for a first-time CPAP user program. Data from 27 participants were collected via four sleep apnea patient and four partner focus groups. Qualitative content analysis identified five themes: knowledge of sleep apnea, effects of sleep apnea, effects of CPAP, barriers and facilitators of CPAP, and ideas for a new user support program. Patients and partners emphasized the importance of partner involvement in the early CPAP treatment period. These data suggest consideration of a couple-oriented approach to improving CPAP adherence.
    Behavioral Sleep Medicine 09/2014; DOI:10.1080/15402002.2014.946597 · 2.34 Impact Factor
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    • "In this study, unlike in our studies, the bed partners were actively involved in the initial phase of education to CPAP, three nights CPAP titration in the sleep center were performed, a home visit at the 14th day and at the beginning of the fourth month therapy was made. Probably, these factors were important reinforcing elements in the long-term adherence to CPAP therapy [20]. "
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    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.
    BMC Pulmonary Medicine 05/2014; 14(1):78. DOI:10.1186/1471-2466-14-78 · 2.40 Impact Factor
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    • "In reviewing interventional studies to improve CPAP adherence , we found two studies that intended to involve spouses or partners [64] [69]. Hoy et al. [64] tested the effect of an intensive education and support program on CPAP adherence, in which spouses were invited to participate in the initial CPAP education and follow-up home visits. Richards and colleagues [69] also mentioned their inclusion of participants' partners in their cognitive behavioral therapy. "
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    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.
    Sleep Medicine Reviews 05/2014; 19. DOI:10.1016/j.smrv.2014.04.005 · 8.51 Impact Factor
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