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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    • "Each type of intensive support had similar activities that were performed during these sessions. [18] [19] [20] [21] [22] The activities consisted of CPAP adherence, assessing for the presence of any side effects with CPAP, equipment review and finally, a mask fitting was performed. Overall patient education and intensive support were the two most effective interventions shown to increase CPAP adherence . "

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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.
    Full-text · Article · Sep 2014 · Behavioral Sleep Medicine
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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.
    Full-text · Article · May 2014 · BMC Pulmonary Medicine
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