Relationship Quality and CPAP Adherence in Patients With Obstructive Sleep Apnea

Department of Psychology, University of Utah.
Behavioral Sleep Medicine (Impact Factor: 2.34). 02/2009; 7(1):22-36. DOI: 10.1080/15402000802577751
Source: PubMed


The prospective influence of relationship support and conflict on adherence to continuous positive airway pressure (CPAP) was examined over the first 3 months of CPAP treatment in 42 married, male patients with obstructive sleep apnea (OSA). CPAP adherence reports were available for 23 patients. Patient ratings of marital conflict predicted average nightly adherence (beta = -0.357, p < .05), but ratings of marital support did not predict adherence. Three-month follow-up ratings of marital support and conflict, subjective sleepiness, depression, and functional impairment were available for 16 patients from the first sample. Six additional patients without adherence reports provided baseline and 3-month follow-up questionnaire data, which resulted in a total of 22 patients with follow-up questionnaire data. Following 3 months of CPAP, patients reported decreased marital conflict (d = 0.43, p < .05), sleepiness (d = 1.13, p < .001), depression (d = 0.73, p < .001), and functional impairment (d = 1.48, p < .001). These findings highlight the importance of evaluating marital conflict for OSA patients and suggest marital conflict may be a target for interventions to improve CPAP adherence.

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    • "Partners indicated reductions in irritability over sleep loss, being able to resume bed sharing, and improved marital quality after CPAP treatment. Limited findings from crosssectional and longitudinal studies examining the impact of CPAP on relationship functioning suggest that marital satisfaction improves with sleep apnea treatment (Baron et al., 2008; Kiely & McNicholas, 1997; McFadyen, Espie, McArdle, Douglas, & Engleman, 2001). Whereas several patients had no problems during the initial experience of using CPAP, the majority found it to be challenging with particular difficulties associated with adjustment and comfort of the mask. "
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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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    • "Results from recent studies examining co-sleeping [73] [74], relationship quality [46], and facilitators of and barriers to CPAP use [75] have suggested the important role spouses play in CPAP adherence. For example, one study reported that during the first week of treatment, patients living alone used CPAP an average of 3.2 h per night, whereas patients who lived with a partner used CPAP for 4.5 h [73]. "
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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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    • "Self-efficacy (ref ¼ increase) Increase Trupp, 2011, 138 Sawyer, 2011, 56 Stepnowsky, 2006, 105 Aloia, 2005 68 No difference Wallace, 2013,* ,51 Bakker, 2011, 52 Ye, 2012,* ,57 Baron, 2009, 60 Olsen, 2008, 64 Wild, 2004, 72 Stepnowsky, 2002, 114 Sage, 2001* ,77 Readiness to change (ref ¼ increased) No difference Aloia, 2005* ,68 Decisional balance (ref ¼ pros outweigh cons) "
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    ABSTRACT: To date, continuous positive airway pressure (CPAP) is the most effective intervention in the treatment of obstructive sleep apnoea, but adherence to this treatment is often less than optimal. A variety of factors and interventions that influence and improve CPAP use have been examined. There is increasing recognition of the multifaceted nature of CPAP adherence: the patient's psychological profile and social environment have been recognised, in addition to the more extensively researched patient's treatment and physiological profile. Understanding how these multiple factors impact on CPAP use in an integrative fashion might provide us with a useful holistic model of CPAP adherence. This concept of integration - a biopsychosocial (BPS) approach to health and illness - has previously been described to understand care provision for various chronic health disorders. This paper proposes an adherence framework, whereby variables integrally affect CPAP use. The BPS model has been considered for nearly 35 years; the presence of poor CPAP adherence was acknowledged in the early 1990s - it is timely to incorporate this approach into our care pathway of CPAP users.
    Sleep Medicine Reviews 05/2013; 18(2). DOI:10.1016/j.smrv.2013.03.002 · 8.51 Impact Factor
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