Article

Sleeping Together: A Pilot Study of the Effects of Shared Sleeping on Adherence to CPAP Treatment in Obstructive Sleep Apnea

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Abstract

To examine the sleep of married couples, recorded together in the laboratory before and after the husband is treated with continuous positive airway pressure (CPAP) to control his obstructive sleep apnea (OSA). The purpose was to investigate how these data relate to shared sleeping when he is on CPAP and his adherence to this treatment. Following a split-night diagnosis of OSA with CPAP titration, 10 married men slept for 2 additional nights with their non-apneic wife while both were recorded. The first night included a standard baseline 12-channel clinical polysomnogram without treatment. Following 2 weeks of home CPAP, the couple returned for a second polysomnography night with the husband on CPAP. Both partners completed Epworth Sleepiness Scales and Sleep Apnea Quality of Life Interviews each lab night. During the intervening 2 weeks, sleep logs were completed daily noting if CPAP was used, the presence of snoring, and where and how well they slept. Adherence data from machine downloads were obtained after an average of 4.6 months. The husbands' baseline sleep differed significantly from their wives on 6 of 7 sleep variables related to OSA and on Epworth Sleepiness Scale scores. Their sleep did not differ the second night, except for his lower percentage of slow wave sleep. Adherence to CPAP was unrelated to OSA severity but positively related to the number of nights the couple slept together during the 2 weeks of home CPAP. The frequency of sleeping together was negatively related to the wives' arousal frequency on laboratory nights. Although CPAP controls a husband's sleep-related OSA symptoms, his treatment adherence is strongly related to his wife sharing the bed. Addressing the wife's sensitivity to arousals when bed sharing may improve the husband's treatment adherence.

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... Several studies have measured the effects of OSA particularly on bed partners, whose sleep quality and quality of life are negatively affected (51)(52)(53). Subjects suffering from OSA complain of poor personal relationships (54). The patient's excessive daytime sleepiness (EDS) may be manifested as irritability or mood swings that harm the relationships between couples (17). ...
... Moreover, having a healthy relationship and being a motivating co-sleeper, wives can even have a supportive effect on the use of CPAP. A study conducted by (54) reported that adherence of OSA patients to CPAP treatment was strongly related to sharing the bed, i.e. the number of nights both couples shared their beds during the 2 weeks of the study (54). On the other hand, if relationship problems are presumed to be a considerable factor in causing or maintaining a sleep disorder, couples' counseling should be considered an adjunct to treatment (70). ...
... Moreover, having a healthy relationship and being a motivating co-sleeper, wives can even have a supportive effect on the use of CPAP. A study conducted by (54) reported that adherence of OSA patients to CPAP treatment was strongly related to sharing the bed, i.e. the number of nights both couples shared their beds during the 2 weeks of the study (54). On the other hand, if relationship problems are presumed to be a considerable factor in causing or maintaining a sleep disorder, couples' counseling should be considered an adjunct to treatment (70). ...
Article
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Introduction: Obstructive sleep apnea (OSA) is a widely prevalent sleep-related breathing disorder, which leads to several life-threatening diseases. OSA has systemic effects on various organ systems. Untreated OSA is associated with long-term health consequences including hypertension, heart disease, diabetes, depression, metabolic disorders, and stroke. In addition, untreated OSA was reported to be associated with cognitive dysfunction, impaired productivity at the workplace and increased risk of motor vehicle accidents (MVAs) resulting in injury and fatality. Other consequences of OSA include, but not limited to, impaired vigilance, daytime somnolence, performance deficits, morning headaches, mood disturbances, neurobehavioral impairments, and general malaise. Additionally, OSA has become an economic burden on most health systems all over the world. Many legal driving license regulations have been developed to reduce MVAs among OSA patients. Methods: The personal, societal, public health and legal aspects of OSA are reviewed. Data were collected through the following databases: MEDLINE, Google Scholar, Scopus, SAGE Research Methods, and ScienceDirect. Conclusion: OSA leads to worsening of patients’ personal relationships, decreasing work productivity, and increasing occupational accidents as well as MVAs. The costs of undiagnosed and untreated OSA to healthcare organizations are excessive. Thus, proper management of OSA will benefit not only the patient but also provide widespread benefits to society as a whole
... In patients with chronic disease, perceived spousal support and involvement have been associated with both improvements and decrements in adherence to medical treatments (Dohery, Schrott, Metcalf, & Iasiello-Vailas, 1983;Stephens et al., 2013). Little is known about the role of relationship factors in CPAP use, but available studies suggest that partners likely exert both positive and negative effects on an individual's adoption and use of CPAP (Baron, Gunn, Czajkowski, Smith, & Jones, 2012;Baron et al., 2011;Baron, Smith, Czajkowski, Gunn, & Jones, 2008;Broström et al., 2010;Cartwright, 2008;Hoy, Vennelle, Kingshott, Engleman, & Douglas, 1999). Perceived collaborative spousal involvement has been shown to increase following nights with lower CPAP adherence and greater reported CPAP problems, and is associated with greater subsequent CPAP adherence. ...
... These findings support prior qualitative and quantitative studies that reported poor sleep quality and impaired health-related quality of life in partners of patients with sleep apnea (Broström et al., 2010;Doherty et al., 2003;Henry & Rosenthal, 2013;McArdle et al., 2001;Parish & Lyng, 2003). Furthermore, cross-sectional studies have shown adverse associations between sleep apnea and relationship quality as reported by the patient or the bed partner (Cartwright, 2008;Virkkula et al., 2005). Interviews with sleep apnea patients and their partners revealed deteriorating or strained relationships resulting from mutual sleep loss due to sleep apnea and spousal anxiety about their partners' health (Henry & Rosenthal, 2013). ...
Article
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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.
... 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]. ...
... 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]. In a small study examining male patients with OSA and their wives, CPAP use in the first 2 weeks was positively related to the number of nights the couple slept together [74]. These findings suggest that CPAP adherence may not be due solely to the patient's effort to utilize this therapy. ...
Article
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.
... Some research suggests that self-reported nonapneic snoring also has important clinical implications such as increased risk for cardiovascular disease [12,13]. Besides these comorbidities affecting the primary snorer, snoring 1 3 can also have negative impact on the sleep quality of the bed partner [14][15][16][17]. Habitual loud snoring may result in couples choosing to sleep apart or resort to using earplugs to counteract the sound [14]. ...
... Besides these comorbidities affecting the primary snorer, snoring 1 3 can also have negative impact on the sleep quality of the bed partner [14][15][16][17]. Habitual loud snoring may result in couples choosing to sleep apart or resort to using earplugs to counteract the sound [14]. These aspects can have a negative impact on the psychosocial aspects and the intimacy in a couple's relationship, and even may trigger marital disharmony or result in divorce [1]. ...
Article
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Purpose: To evaluate the effect of a new-generation positional device, the sleep position trainer (SPT), in non-apneic position-dependent snorers. Methods: Non-apneic position-dependent snorers with an apnea-hypopnea index (AHI) < 5 events/h were included between February 2015 and September 2016. After inclusion, study subjects used the SPT at home for 6 weeks. The Snore Outcome Survey (SOS) was filled out by the subjects at baseline and after 6 weeks, and at the same time, the Spouse/Bed Partner Survey (SBPS) was filled out by their bed partners. Results: A total of 36 participants were included and 30 completed the study. SOS score improved significantly after 6 weeks from 35.0 ± 13.5 to 55.3 ± 18.6, p < 0.001. SBPS score also improved significantly after 6 weeks from 24.7 ± 16.0 versus 54.5 ± 25.2, p < 0.001. The severity of snoring assessed with a numeric visual analogue scale (VAS) by the bed partner decreased significantly from a median of 8.0 with an interquartile range (IQR) of [7.0-8.5] to 7.0 [3.8-8.0] after 6 weeks (p = 0.004). Conclusions: Results of this study indicate that positional therapy with the SPT improved several snoring-related outcome measures in non-apneic position-dependent snorers. The results of this non-controlled study demonstrate that this SPT could be considered as an alternative therapeutic option to improve sleep-related health status of snorers and their bed partners.
... Divergence in sleep rhythm may also be one of the reasons why partners quarrel at an early stage of their relationship when their sleep rituals are not matched [22]. A different from the typical sleep rhythm of one of the partners may become a problem of both, just as insomnia [23] or snoring [24][25][26]. ...
... Rozbieżność rytmu snu może stać się także jednym z powodów kłótni partnerów na wczesnym etapie związku, kiedy ich rytuały związane ze snem nie są dopasowane [22]. Odmienny od typowego rytm snu jednego z partnerów może stać się problemem obojga, tak samo jak bezsenność [23] czy chrapanie [24][25][26]. ...
Article
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Purpose: Delayed Sleep-Wake Phase Disorder (DSWPD) occurs in 7-16% of young people. Development of this disorder is favored by prolonged and late use of electronic devices, shift work, irregular meal times and other socio-cultural changes. The aim of the article is to describe the case study and to analyze treatment of the patient with a diagnosis of DSWPD. Case description: A 28-year-old man who reported negative impact of sleep disorders on the quality of his marital relationship, including the quality of sex life. Previous treatment with a sleeping medicine was not effective. Only the use of a full chronobiological treatment program, in line with current standards, and melatonin therapy has led to significant improvement in his condition. Comment: DSWPD is a disorder that significantly affects the quality of life and daily functioning, not only of the patient but also of his family. Recommended treatment methods include melatonin therapy, phototherapy, and behavioral interventions.
... This high prevalence translates to millions of individuals who experience negative health consequences such as cardiac disease, stroke, cognitive decline and premature death. Nasal continuous positive airway pressure (CPAP) is currently the most effective and most commonly prescribed treatment for OSA, which involves loud snoring and frequent arousals (Cartwright et al., 2008). Unfortunately, acceptance and long-term commitment to CPAP treatment, for enough hours during the night to be effective, remains a challenge. ...
... Therefore, ethnographic qualitative interview questions are well positioned to help us gauge patients' sleep attitudes and sleep-related beliefs. That is, treatment adherence to CPAP in married men is strongly associated with the frequency with which his partner sleeps with him during his initial home treatment (Cartwright et al., 2008). ...
Thesis
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Sleep Medicine has evolved rapidly over the past six decades, reflecting increased understanding about and prevalence of sleep disorders. One of those disorders, obstructive sleep apnea (OSA), is particularly common. It disproportionally affects veterans; up to 48% of them may have the disorder. Yet, despite improvements in OSA diagnosis and treatment, adherence to that treatment is poor and tools to enhance it remain elusive. There is a paucity of medical anthropological research identifying ecological and cultural factors that could lead to poor treatment adherence. To better understand differing adherence patterns in rural north Georgia veterans with OSA, we conducted quantitative and qualitative analyses based on standard questionnaires and phone interview scripts. Analysis of veterans’ narratives generated from those interviews identified key predictors of treatment adherence. Notably, more adherent patients reported higher satisfaction with life, slept longer, and were more likely to co-sleep with a bed partner compared to less adherent patients. These findings could help guide the development of more effective interventions to promote OSA treatment adherence.
... 4,5 In addition to improving health and quality of life for patients, spouses of OSA patients also report benefi ts from the patient using CPAP, including decreased sleepiness and improved sleep quality and relationship satisfaction. [6][7][8][9] Despite these benefi ts, 46% to 83% of patients do not adhere to CPAP treatment, which means studying factors associated with adherence to CPAP are a necessary and important task. 10,11 Frequently, patients report the spouse is a main factor in their decision to seek treatment for OSA. ...
... Sharing a bed with a spouse or partner has been associated with higher adherence in two studies. 8,14 However, higher marital confl ict and seeking treatment because of a spouse (rather than self-referral) have been associated with poorer adherence. 15,16 The discrepancy in these fi ndings may be due to the specifi c nature of spousal interactions with respect to CPAP use. ...
Article
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Continuous positive airway pressure (CPAP) improves sleep and quality of life for both patients with obstructive sleep apnea (OSA) and their spouses. However, few studies have investigated spousal involvement in treatment adherence. Aims of this observational study were to assess perceptions of spousal involvement and evaluate associations between involvement and adherence. Spousal involvement in CPAP adherence was assessed in 23 married male OSA patients after the first week of treatment. At 3 months, 16 participants completed a second assessment of spousal involvement. Types of involvement assessed included positive (e.g., encouraging), negative (e.g., blaming), collaboration (e.g., working together), and one-sided (e.g., asking). An interpersonal measure of supportive behaviors was also administered at 3 months to evaluate the interpersonal qualities of spousal involvement types. Objective CPAP adherence data were available for 14 participants. Average frequency of spousal involvement ratings were low for each involvement type and only negative spousal involvement frequency decreased at 3 month follow-up (p = 0.003). Perceptions of collaborative spousal involvement were associated with higher CPAP adherence at 3 months (r = 0.75, p = 0.002). Positive, negative and one-sided involvement were not associated with adherence. Collaborative spousal involvement was associated with moderately warm and controlling interpersonal behaviors (affiliation, r = 0.55, p = 0.03, dominance r = 0.47, p = 0.07). Patients reported low frequency but consistent and diverse perceptions of spousal involvement in CPAP over the first 3 months of treatment. Perceptions of collaborative spousal involvement were the only type associated with adherence and represent moderately warm and controlling interpersonal behavior. Interventions to increase spousal collaboration in CPAP may improve adherence.
... CPAP is the first-line treatment but, because of discomfort and side-effects, compliance with CPAP is difficult for most people and has been reported to be especially so for patients with schizophrenia (Lin & Winkelman, 2012). Having no bed partner (Baron et al., 2012;Cartwright, 2008;Gagnadoux et al., 2011), unemployment (Gagnadoux et al., 2011) and poverty (Simon-Tuval et al., 2009) are all associated with poor adherence to CPAP, and these all apply to B.L., as they do to most individuals with schizophrenia. Overall, relative to men, women are considered to show relatively good compliance with CPAP, but this may not hold for older women on psychoactive medication (Campos-Rodriguez et al., 2013). ...
Article
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Background: Obstructive sleep apnoea (OSA) is often overlooked in the context of schizophrenia because its hallmark, daytime sleepiness, is so easily attributable to antipsychotic drugs. This is a special problem for women. Aims: To underscore the importance of diagnosing and treating OSA in women with schizophrenia. Methods: A review of the recent literature (search terms: Obstructive Sleep Apnoea; Schizophrenia; Women (or Gender); Obesity; Antipsychotics; Continuous Positive Airway Pressure (CPAP)) as it applies to a composite case vignette taken from the files of a specialty clinic that treats women with psychosis. Results: The rate of OSA in women who are both obese and postmenopausal is very similar to that of men. Family history, smoking, and the use of tobacco, alcohol and of antipsychotic medication increase the risk. Despite reluctance, patients with schizophrenia generally agree to undergo sleep studies. Compliance with CPAP is difficult, but can be aided by the physician and is, on the whole, relatively high in women. CPAP improves sleep parameters and may also improve cardiometabolic and cognitive indices, although this still needs to be more fully researched. Conclusion: Schizophrenia and untreated OSA are both associated with high mortality rates in women as well as men.
... It has been shown that the Epworth Sleepiness Scale (ESS) is an early predictor of CPAP adherence [10,11], whereas biomedical indices of disease severity such as the body mass index (BMI), AHI, and CPAP do not predict more than 10% of the variance in CPAP adherence [9,10]. CPAP adherence seems to be largely explained by psychological variables [10][11][12][13][14][15][16][17]. Currently, generic quality of life questionnaires are used for CPAP-treated OSAS patients, mainly the Short-Form 36 Health Survey questionnaire (SF-36) [18], together with questionnaires designed to assess sleep quality [19] or daytime sleepiness [20]. ...
Article
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The nightly use of continuous positive airway pressure (CPAP) increases the quality of life of patients affected by obstructive sleep apnea syndrome (OSAS). The aim of this study was to develop and validate a questionnaire to assess the psychological and physical impact of OSAS and adherence to the CPAP device. Ninety-six patients underwent a polygraphic examination to establish a diagnosis of OSAS. They attended educational sessions concerning CPAP and completed the Maugeri Obstructive Sleep Apnea Syndrome (MOSAS) questionnaire before the adaptation phase to the device and after six months, when the number of hours of CPAP use was documented. Exploratory and confirmatory factor analysis of MOSAS section A revealed two factors with good internal consistency: "Sleep Apnea Psychological Impact" (α=0.77) and "Sleep Apnea Physical Impact" (α=0.75). Structural equation modeling confirmed the goodness of fit of the structure to the observed (RMSEA=0.034; GFI=0.95; AGFI=0.92; and CFI=0.96). MOSAS section B, which assesses the "discomfort and nuisance of CPAP," is mono-factorial with good internal consistency (α=0.663). The Psychological Impact factor positively correlated with the anxiety (r=0.44) and depression scores (r=0.49) and the physical impact factor positively correlated with daytime sleepiness (r=0.65). The discomfort and nuisance of CPAP negatively correlated with recorded CPAP use after six months (r=-0.52). The statistical quality of MOSAS is good, and it can be used to assess the psychological and physical impact of OSAS and subjective adherence to a CPAP device.
... For replication purposes we also examined whether baseline sleepiness, self-efficacy, acceptance of treatment, intentions to adhere, depressive or anxiety symptoms, general health, insomnia symptom severity, and frequency of sleeping with a "bed partner or pet" were also associated with subsequent adherence rates. Bed partner or pet status was of particular interest because previous literature suggests involving a bed partner affects adherence to treatment for other sleep disorders (Baron et al., 2011;Cartwright, 2008). ...
Article
Behavioral interventions for insomnia are effective in improving sleep, yet adherence is variable, and predictors of adherence have not been consistently replicated. The relationships between daily variations in state factors at the initiation of treatment and adherence have not been investigated. Using two-week, self-report online logs, this study determined, among 53 college students with probable insomnia, the associations of pre-treatment factors and daily factors during treatment on daily variations in adherence to one session of behavioral treatments for insomnia. These treatments included stimulus control therapy (SCT), sleep restriction therapy (SRT), and sleep hygiene (SH). Low self-efficacy was associated with poorer SCT and SH adherence. Participants with a “bed partner or pet” at least some of the time had better SCT adherence. Greater total sleep time and poorer sleep quality were associated with poor SCT and SRT adherence the following night. Greater sleep efficiency was related to greater next night SCT and SRT adherence. Alcohol consumption was related to poorer SRT and SH adherence the following night. Future studies should test the replicability of these findings. Adherence trials may want to test whether discouraging alcohol intake, enhancing treatment-related self-efficacy, and monitoring and providing feedback on sleep, early in treatment, affects adherence.
... In this context, partners can influence the approach to therapy, the therapist, and levels of engagement with the active components of the therapy (i.e., partner alliance). Specific to the domain of behavioral sleep medicine (BSM), involving partners in the management of continuous positive airway pressure (CPAP) can have a beneficial impact on levels of adherence (Baron et al., 2011;Cartwright, 2008). That said, if the quality of support is perceived as negative or unwanted (e.g., perceived as nagging or intrusive) it can negatively influence outcomes (Gorin, Le Grange, & Stone, 2003;Kuijer et al., 2000;Magill et al., 2010). ...
Article
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Despite cognitive behavioral therapy for insomnia (CBT-I) being effective, barriers to adherence have been documented. Perceived partner alliance has been shown to influence adherence and treatment outcome across a range of other health conditions. The present study examined patients' perceptions regarding the role of their partner in CBT-I and the impact of perceived partner alliance on treatment outcome. Twenty-one patients were interviewed, following CBT-I, to examine the areas where partners were thought to influence the process of CBT-I. The majority of statements made during interviews explicitly mentioned a partner's influence (65%). Additionally, the production of more positive partner statements was associated with better treatment outcome (using the Insomnia Severity Index). The integration of perceived partner alliance into CBT-I is discussed.
... Moreover, wives can even have a supportive effect on the use of CPAP. In a study by Cartwright (2008), treatment adherence was strongly related to the wife sharing the bed. After 2 weeks of CPAP, men's score on the Sleep Apnea Quality of Life index improved and was significantly higher than the wife's score, indicating that the man was better adjusted to his diagnosis and treatment than she was. ...
Article
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Objective: To summarize research on couple sleeping with respect to gender-specific differences and chronotype. Methods: Systematic review of the literature. Results: Millions of adults around the world share their beds with a partner. This may be an expression of intimacy and attachment and tends to intensify romantic relationships. Yet, couple sleeping still has underestimated implications for the quality of the relationship, quality of sleep and for physical and psychological health which are not consistently positive. Implications for research and therapy are discussed. Conclusions: Despite the people involved perhaps not even being aware of their nocturnal interactions, it is important that sleeping together becomes a subject of discussion. Abbreviations: REM: rapid eye movement; QOL: quality of life; OSA: obstructive sleep apnea; CPAP: continuous positive airway pressure
... Several studies in adults have also examined the dyadic context of sleep by investigating the impact of the quality of close relationships on various aspects of sleep. Findings have shown beneficial effects of the relationship with a partner on compliance with healthy behaviors and treatments targeting sleep disorders [46,47]. Moreover, poor marital quality has been linked to insomnia in several studies [48e52]. ...
Article
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Based on early life experiences in which developmental, genetic, and environmental components interact, humans learn to trust themselves and others and connect emotionally in consistent ways that are broadly defined as “attachment styles.” These relatively stable patterns of interpersonal interaction are associated with either vulnerability to various health risks or resilience. Similarly, the mechanisms involved in sleep regulation undergo developmental changes that overlap temporally with attachment formation and remain sensitive to a series of biological, environmental and psychological influences. Interestingly, while sleep has been conceptualized as a fundamental attachment behavior given its dyadic context, few studies have explored its relationship with attachment style in various ages. We present the first systematic review of the published literature examining the relationship between attachment style and sleep in humans across the life span. While levels of evidence and methods of assessment vary significantly, the results suggest a possible life-long relationship between individual attachment style and sleep. These findings are particularly useful in understanding relatively ingrained psychological mechanisms that can affect and be affected by sleep. Clinical and research implications are discussed.
... El compromiso de la familia o de la pareja, el conocimiento de la frecuencia de la patología y la certeza de que numerosos pacientes usan el dispositivo puede ser estimulante para mejorar la adherencia. Nuestra modalidad de trabajo incluyó invitar sistemáticamente a el/ la pareja o compañero/a de cuarto, ya que interesa lograr colaboración respecto del tratamiento con CPAP por el entorno del paciente (feedback), y se han descripto mejores resultados cuando esta interacción se logra 41,42 . ...
... There are numerous other variables that may influence PAP adherence which were not addressed in this study, including but not limited to marital status, living/sleeping arrangements, employment, race, and socioeconomic status. [33][34][35][36] However, in performing the regression analyses, we did find that age was a significant independent factor in predicting compliance, with increasing age associated with small increases in the percentage of nights used > 4 hours and nightly hours of use. In most studies on CPAP adherence, age has not been shown to be a predictor of compliance [39][40][41][42] ; however, in one study analyzing use in a large cohort, increasing age was associated with increased number of days of use and hours used per night. ...
Article
A chinstrap is potentially useful to reduce unintentional air leak by preventing mouth opening during PAP treatment. This study examines whether the addition of a chinstrap to PAP therapy has any effect on adherence, nightly duration of use, air leak, and residual AHI. This was a retrospective study performed at an AASM-accredited VAMC sleep center. Clinical sleep data of veterans (n = 124) prescribed PAP therapy for sleep apnea was evaluated, and the effect of chinstrap use vs non-use on the above parameters was assessed. Chinstrap users had significantly greater PAP adherence, longer nightly duration of PAP use, lower residual AHI and lower leak compared to chinstrap non-users at first follow up visit. The addition of a chin strap to PAP therapy is a simple and inexpensive method of increasing PAP adherence. Knowles SR; O'Brien DT; Zhang S; Devara A; Rowley JA. Effect of addition of chin strap on PAP compliance, nightly duration of use, and other factors. J Clin Sleep Med 2014;10(4):377-383.
... Given that 61% of adults share a bed with a partner 10 , the consequences of OSA, including fragmented sleep, reduced quality of life, and increased marital con ict, affect both the patient and partner 11,12 . Further, given that sleep fragmentation is also mechanistically linked with increased risk for cognitive decline and is a symptom experienced by both the patient with OSA and their bedpartner 13 , the public health consequences of OSA are far greater than just that experienced by the patient alone. ...
Preprint
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Background Obstructive sleep apnea (OSA) is a serious health condition that affects approximately 30–50% of older adults and contributes to risk for cardiometabolic disorders and dementia. Despite the well-documented role of partners in treatment seeking and adherence to positive airway pressure (PAP), treatments for OSA have nearly exclusively focused on the patient and current treatments for OSA do not address co-existing sleep problems such as insomnia that are prevalent in both patients with OSA and their partners. Therefore, the goal of this study is to develop and test a novel couples-based sleep health intervention to promote adherence to PAP and improve sleep health of the couple.Methods We are conducting a two-arm, parallel group, single blind, randomized controlled pilot/feasibility trial to compare our novel couples-based sleep health intervention (We-PAP) to an information control group (IC). We-PAP is based on a transdiagnostic model and uses a dyadic approach including increasing effective partner support, communication skills, and couple-level goal-setting. We-PAP involves 3 sessions and is delivered via telehealth in weekly sessions. The IC includes standardized patient educational materials. Both groups receive the usual follow-up with their medical team. The study involves assessments at pre-treatment, post-intervention (approximately 1 month after starting PAP and completing We-PAP sessions or IC) and 3 months after starting PAP. Our main outcomes are feasibility and acceptability ratings. Secondary outcomes include comparing We-PAP to IC for PAP adherence, sleep quality (self-report and objective) and cognitive measures.DiscussionWe-PAP is the first couples-based transdiagnostic sleep health intervention for patients with OSA and their partners. Results of this study will be used to inform the design of a subsequent fully adequately-powered clinical trial. If successful, this intervention could significantly advance current clinical practice in the treatment of OSA and sleep health more comprehensively in older adults. Moreover, this intervention may be useful for improving sleep in other aging populations with multiple sleep and other health problems, including patients with chronic illnesses or those at risk for Alzheimer’s disease and their caregivers.Trial registrationNCT04759157
... CPAP users who are married or in a live-in relationship show higher compliance compared with those who live alone [ 39 , 42 ]. A spouse or partner may provide feedback about the effect of CPAP therapy such as elimination of symptoms and improvement in quality of life, which could contribute to higher CPAP compliance [ 43 ]. ...
Chapter
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Obstructive sleep apnea (OSA) is a disorder that is characterized by obstructive apneas and hypopneas resulting from repetitive collapse of the upper airway during sleep, which is attributed to several causes that can be classified into anatomical factors such as maxillofacial structure changes or redundant soft tissues of the upper airway and physiological factors such as defects in upper airway muscles and function. OSA is a serious medical illness. If left untreated, OSA increases both morbidity and mortality. OSA has been shown to increase the risk of hypertension, stroke, and cardiovascular complications. Moreover, OSA increases the risk of motor vehicle accidents. Continuous positive airway pressure (CPAP) is the treatment of choice for OSA. It is an effective therapy that reduces morbidity and mortality; however, CPAP adherence remains a major obstacle [3]. CPAP compliance has been reported to range from 20 to 84 %, depending on the design of the study, the definition of compliance, and the population examined. This chapter discusses CPAP compliance, factors that influence compliance, how to monitor CPAP compliance, interventions to improve CPAP compliance, and common side effects of CPAP therapy.
... More than many other diseases and treatments, OSA and CPAP treatment affect not only the patients, but also their partners. Recent studies examining bed-sharing and spousal involvement of CPAP treatment have suggested the important impact a partner can have on adherence to CPAP (Baron et al., 2010;Cartwright, 2008). In fact, patients with OSA have described spousal support as an important facilitator, while insufficient spousal engagement as a major barrier to their adherence to CPAP, suggesting the critical need to involve spouses or domestic partners to promote CPAP use (Brostrom et al., 2010). ...
Article
This study aimed to identify pre-treatment and immediate early treatment factors predicting continuous positive airway pressure (CPAP) use during the first week of therapy, when the pattern of non-adherence is established. Four domains of potential predictors were examined: pre-treatment demographic and clinical factors, patients' perceived self-efficacy, treatment delivery (mask leak and bothering side effects) and immediate disease reduction (residual respiratory events and flow limitation). The Autoset™ Clinical System objectively documented daily CPAP use, mask leak, residual respiratory events and flow limitation. Ninety-one CPAP-naive patients with newly diagnosed obstructive sleep apnea were followed for 1week after treatment initiation. Mean CPAP daily use during the first week was 3.4±2.7h, with significantly lower use observed in black than non-black participants (2.7 versus 4.4h, respectively, P=0.002). Less intimacy with partners caused by CPAP was the only treatment side effect correlated with CPAP use (r=-0.300, P=0.025). Reduced CPAP use during the first week was associated simultaneously with being black, higher residual apnea-hypopnea index and the treatment side effect of less intimacy with partners. The three factors together accounted for 25.4% of the variance in the CPAP use (R(2) =0.254, P<0.01). These data suggest the need to assess the impact of CPAP on intimacy and troubleshooting aspects of the treatment that interfere with sexual relationships. Assessing the presence of residual respiratory events may be important in promoting CPAP adherence. The association of race and CPAP use needs to be explored further by including more socioeconomic information.
... The bed partner's post-treatment sleep quality and overall quality of life were also demonstrated to influence CPAP adherence [40]. In a small population of married men, CPAP adherence was strongly related to the frequency with which the couple slept together [41]. Recent studies have more extensively investigated how the social context of daily life may impact on perceptions of CPAP treatment [42,43]. ...
Article
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Long-term adherence is a major issue in patients receiving home continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS). In a multicenter prospective cohort (the Institut de Recherche en Santé Respiratoire des Pays de la Loire [IRSR] sleep cohort) of consecutive OSAHS patients in whom CPAP had been prescribed for at least 90 days, we studied the impact on long-term treatment adherence of socioeconomic factors, patients and disease characteristics prior to CPAP initiation. Among 1,141 patients in whom CPAP had been prescribed for an average of 504±251 days (range: 91 to 1035), 674 (59%) were adherent with a mean daily use of CPAP≥4 h (mean: 6.42±1.35 h). Stepwise regression analysis identified 4 independent factors of CPAP adherence including apnea-hypopnea index (AHI) (OR: 1.549, 95%CI 1.163 to 2.062 for AHI≥30 vs. AHI<30; p = 0.003), body mass index (BMI) (OR: 1.786, 95%CI 1.131 to 2.822 for BMI≥25 and <30 kg/m(2), p = 0.01; OR: 1.768, 95%CI 1.145-2.731 for BMI≥30 kg/m(2), p = 0.01 vs. BMI<25 kg/m(2)), employment status (OR: 1.414, 95%CI 1.097-1.821 for retired vs. employed; p = 0.007) and marital status (OR: 1.482, 95%CI 1.088-2.019 for married or living as a couple vs. living alone; p = 0.01). Age, gender, Epworth sleepiness scale, depressive syndrome, associated cardiovascular morbidities, educational attainment and occupation category did not influence CPAP adherence. Marital status and employment status are independent factors of CPAP adherence in addition to BMI and disease severity. Patients living alone and/or working patients are at greater risk of non-adherence, whereas adherence is higher in married and retired patients. These findings suggest that the social context of daily life should be taken into account in risk screening for CPAP non-adherence. Future interventional studies targeting at-risk patients should be designed to address social motivating factors and work-related barriers to CPAP adherence.
... 39 Cartwright examined the association between bed sharing and CPAP adherence during the first 2 w of treatment. 40 A greater number of nights the couple slept together based on wives' sleep log was significantly associated with higher average hours of CPAP use during the initial 2-w treatment period. Partners' reports of increased bed sharing since initiation of OA was associated with self-reported use of OA at a median 7 mo after fitting. ...
Article
Study objectives: Many adults sleep with a significant other; thus, sleep disorder symptoms and treatments of one partner are likely to impact the other partner's health. A literature review was conducted to examine the impact of obstructive sleep apnea (OSA) and OSA treatments on partner-assessed sleep and daytime functioning and partner involvement in OSA treatment. Methods: MEDLINE, EMBASE, and CINAHL searches yielded 38 pertinent quantitative and qualitative studies that described sleep and/or daytime functioning assessed in partners of patients with untreated OSA, sleep and/or daytime functioning assessed in partners who were referred for OSA treatment, including continuous positive airway pressure (CPAP) therapy, oral appliance (OA), or surgery, and/or associations between partner involvement and OSA treatment use. Results: The majority of studies found untreated OSA to have a negative impact on partners' objective and subjective sleep and daytime functioning, in particular mood, quality of life, and relationship quality. Improvements in partner-assessed sleep quality were reported for CPAP, OA, and surgery. Conflicting results were reported for partners' mood, quality of life, daytime sleepiness, and relationship quality. Perceived partner support was associated with greater CPAP use. Conclusions: Symptoms associated with OSA can negatively impact partners' sleep and daytime functioning. Treatment of OSA with CPAP, OA, or surgery can have health benefits for not only patients but also partners. Collaborative partner involvement may be a useful strategy for interventions promoting CPAP adherence.
... Moreover, wives can even have a supportive effect on the use of CPAP. In a study by Cartwright (2008), treatment adherence was strongly related to the wife sharing the bed. After 2 weeks of CPAP, men's score on the Sleep Apnea Quality of Life index improved and was significantly higher than the wife's score, indicating that the man was better adjusted to his diagnosis and treatment than she was. ...
... Furthermore, incorporating bed partners into assessment and treatment has shown some promising results for several other sleep disorders, such as obstructive sleep apnea. 87,88 As such, incorporating bed partners into insomnia treatment may provide for a unique opportunity to capitalize on the partner's ability to promote healthy sleep-related behaviors, and simultaneously ameliorate their potential role in maintaining insomnia. ...
... Bed partners are usually the first observers and the first aggrieved party-apart from the sleep-disordered patient-that note and recognize sleep problems. Marital relationships were accordingly researched in some quantitative studies and found to be a relevant issue (Kajaste et al., 2004;Mcfadyen et al., 2001), especially with regard to adherence to treatment with continuous positive airway pressure (CPAP) in sleep-related breathing disorders (SRBD) (Baron et al., 2009;Cartwright, 2008). Qualitative studies evaluating this important factor in the immediate environment of patients with sleep disorders are gradually evolving (Reishtein et al., 2006). ...
Article
We conducted an explorative, cross-sectional, multi-centre study in order to identify the most common problems of people with any kind of (primary) sleep disorder in a clinical setting using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Data were collected from patients using a structured face-to-face interview of 45-60 min duration. A case record form for health professionals containing the extended ICF Checklist, sociodemographic variables and disease-specific variables was used. The study centres collected data of 99 individuals with sleep disorders. The identified categories include 48 (32%) for body functions, 13 (9%) body structures, 55 (37%) activities and participation and 32 (22%) for environmental factors. 'Sleep functions' (100%) and 'energy and drive functions', respectively, (85%) were the most severely impaired second-level categories of body functions followed by 'attention functions' (78%) and 'temperament and personality functions' (77%). With regard to the component activities and participation, patients felt most restricted in the categories of 'watching' (e.g. TV) (82%), 'recreation and leisure' (75%) and 'carrying out daily routine' (74%). Within the component environmental factors the categories 'support of immediate family', 'health services, systems and policies' and 'products or substances for personal consumption [medication]' were the most important facilitators; 'time-related changes', 'light' and 'climate' were the most important barriers. The study identified a large variety of functional problems reflecting the complexity of sleep disorders. The ICF has the potential to provide a comprehensive framework for the description of functional health in individuals with sleep disorders in a clinical setting.
... The spouse or any bedpartner sharing the sleeping vicinity (bedroom or living room) with CPAP users are passive (secondary) users and therefore should be considered in the design of the CPAP system, as they play a significant role in CPAP adherence and overall wellness and quality of life of the patients and of the entire family (Elfstrom et al., 2012;Ye et al., 2015;Cartwright, 2008;Aloia, 2011Luyster et al., 2014. Additional stakeholders for importance are healthcare administrators, insurance companies and regulatory bodies such as the FDA, which determine which medical devices and technologies will be delivered to patients based on social, economic and institutional considerations (e.g., reimbursement) (Klatzky, Kober and Mavor ,1996;Martin et al., 2088;Shapiro and Shapiro, 2010). ...
... It has been reported that OSA patients living alone exhibited poor CPAP adherence [7,25] compared to those who were married or living as a couple [26]. Sharing the same bed also has a positive effect on male OSA patients' CPAP adherence [27]. In most previous studies, the couple was considered as a homogeneous sociodemographic variable that was essentially studied as one of the determinants of CPAP adherence. ...
Article
Background: Continuous positive airway pressure (CPAP) is the first line therapy for obstructive sleep apnea (OSA) but its effectiveness requires high adherence. We aimed to assess the impacts of the spouse's/partner's involvement and the quality of the couple's relationship on CPAP adherence. Methods: In a multicenter prospective study conducted in France, patients reported their subjective views regarding their partner's engagement in their CPAP treatment and the quality of their marital relationship using the Quality of Marriage Index. A hierarchical linear model was built to assess the predictors of CPAP adherence at day 120. Structural equation modeling was performed to evaluate the direct and indirect effects of the spouse's/partner's engagement and the quality of the couple's relationship on CPAP adherence. Results: The 290 OSA patients were predominantly male (77%), with a median age of 53 years IQR: [46; 62], median BMI: 32 kg/m2 [28.6; 35.9] and median apnea + hypopnea index: 43/per hour [33; 58]. Independent factors for CPAP adherence at day 120 were the partner's encouragement of CPAP usage and a stable relationship exceeding 30 years, although emotional support or collaboration were not associated with CPAP adherence. Structural equation modeling demonstrated that spouse's/partner's engagement is directly related to CPAP adherence and improvement of symptoms, and that CPAP adherence is a mediator of disease-specific health-related quality of life. Marital quality was a significant moderator of these interactions meaning that a spouse's/partner's engagement improved adherence only when the quality of marriage index was high. Conclusion: Future research and integrated OSA management should systematically include and document the role of the spouse/partner in CPAP adherence.
... The researchers found that OSA patients had a poor personal relationships due to mood fluctuations, depression, poor social activities, unacceptance of the family of the disease, bad sleep quality of the partner or may be due to erectile dysfunction or abnormal sexual behav- ior. However treatment of the condition (either by continuous positive airway pressure (CPAP), surgery or oral appliance) can improve this problem and saves those stressed relationships [17][18][19][20][21][22]. ...
Article
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Obstructive sleep apnea (OSA) is a sleep disorder that is causing personal and national negative impact in addition to the patient’s health hazards. This mini-review article highlights these issues to encourage more studies concerning this area of the sleep medicine research and draws the attention of the medical authorities to this dangerous disorder.
... Fourth, our intervention strategy will be tailored based on information gleaned from focus groups with patients in our previous randomized controlled trial and will draw from family networks, with a focus on input from participants' partners. Recent evidence shows that partners have either a positive or negative influence on CPAP acceptance [108][109][110][111]. Evidence from our previous RCT suggested that partners are instrumental in facilitating adaptation of CPAP therapy in the home environment. ...
Article
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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.
... Good effects are obtained in many cases by the mechanical restoration of upper airway patency by means of orthodontic prostheses, preventing the tongue falling back and causing a forward movement of the mandible, and the application of nasopharyngeal tubes, the efficiency of which is determined at up to 70%. One basic non-invasive method of treatment is to use CPAP apparatus [6,7,8]. Operative treatment includes a surgical procedure aimed at a reduction in body weight, giving excellent results in patients with high BMI [8,9]. ...
Article
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According to various data, snoring may affect about 2 billion people worldwide, with about 8 million adult people in Poland being estimated to snore. Apart from being disturbing for other people, it brings about a measurable risk for the patient, which results from transient anoxia. As a consequence, it may increase the risk of arterial hypertension, myocardial infarction, cerebral stroke and impotency, as well as mental disturbances like depression or anxiety states. The physician a snoring patient may consult in the first instance is the laryngologist. He determines whether upper airway obturation (in contrast to central sleep apnea) is dealt with, and takes a decision about treatment method, or redirects the patient to another specialist. In this paper, the position of a laryngologist in the diagnosis and treatment of snoring is presented. The material consisted of patients presenting with this problem at the otolaryngology department. The proceedings with patients in the admission office setting were described as well as qualification methods for further medical and operative treatment. A review of the applied procedures was made, in particular allowing for the most recent therapeutic methods.
... Auch die Partnerinnen von Schlafapnoe-Patienten sind besonders belastet, die Lebens-und Schlafqualität beider Partner kann jedoch durch CPAP-Therapie (Continuous Positive Airway Pressure) verbessert werden (24,25). Zusätzlich verbessert die Anwesenheit einer Partnerin im geteilten Bett die Compliance des Mannes bei der CPAP-Therapie (26). ...
Article
In der Literatur werden verschiedene Geschlechtsunterschiede im Chronotypus berichtet, die sich über die Lebensspanne hinweg verändern. In Beziehungen können starke Unterschiedlichkeit in der Tageszeitpräferenz sowie andere schlafbezogene Parameter weit reichende Konsequenzen, etwa für das Sexualleben, mit sich bringen, die jedoch bisher nicht ausreichend untersucht wurden.
... The most common treatment for OSA is continuous positive airway pressure (CPAP), but success of this treatment relies on treatment adherence, which is frequently suboptimal. 2 Strategies to engage patients in increasing CPAP adherence serve as an exemplar for enacting change in sleep behaviors. Results from studies examining co-sleeping, 3,4 relationship quality, 5 and facilitators and barriers of CPAP use perceived by patients 6 have suggested the important role spouses play in CPAP adherence. Unfortunately, previous investigations of CPAP adherence have focused primarily on the diagnosed individual and resulted in limited success. ...
Article
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Objective: The majority of adults sleep with a partner, making sleep a dyadic experience. However, interventions to improve sleep have primarily focused on individuals. This qualitative analysis used a dyadic approach to identify facilitators and barriers to successful treatment of one of the most common sleep disorders, obstructive sleep apnea, with continuous positive airway pressure (CPAP). Methods: Twenty joint qualitative interviews were conducted with couples, one couple at a time, with a sample of 20 patients with obstructive sleep apnea and their partners to develop an understanding of couples' experiences with CPAP use. Interviews were audio recorded and transcribed. Conventional qualitative content analysis was used to analyze the interview data. Results: Facilitators of CPAP use were the following: the partner aiding diagnosis and treatment, couples working together using CPAP, the perceived benefits of CPAP for both partners, the patient being motivated to use CPAP for the benefit of the partner, and various types of support provided by the partner to encourage CPAP use. Major barriers to CPAP use were the following: anxiety related to CPAP use particularly in the beginning of therapy, bothersome equipment causing disruptions in sleep and bedtime routine, interruptions to intimacy, and concern about image change while wearing CPAP. Conclusions: Findings from this study suggest that couple-directed interventions that advocate for a mutually engaging perspective and promote supportive relationships and positive dyadic coping may be targets for improving CPAP adherence. Further research evaluating the potential of couple-focused interventions to improve sleep health is warranted.
... The personas created for the stakeholder events were not meant to provide a global representation of a particular user group but were designed purely as a way to support communication and act as a means to aid discussion and dialogue, as described by Vincent and Blandford (2014 (McArdle et al., 2001). Other research has shown that adherence to CPAP in married men is strongly related to the frequency with which their partners sleeps with them during their initial home treatment and that some wives who sleep in a separate bed or room do not return to share the bed even after the sleep disorder is under control (Cartwright, 2008). For these reasons obstructive sleep apnoea and the CPAP medical device were selected as the topic for this stakeholder event and were used to form the basis of the personas and scenario. ...
Thesis
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Recent increases in life expectancy, combined with the rise of chronic diseases, have led to a rise in the use of medical devices to monitor and treat illnesses in people’s homes. To date, however, little attention has been paid to understanding the impact that these devices have on the home environment, the users of these devices and their partners. This thesis presents three studies investigating the physical, personal and social issues faced by people using home medical devices. The first study consisted of qualitative interviews with 12 device users and seven partners and investigated their experiences of home use medical devices. Analysed thematically, this study described how medical devices can foster or threaten people’s experience of the physical, personal and social aspects of the home environment when medical devices are integrated into their homes. In study two, a questionnaire was developed to investigate the attitudes of healthcare professionals and patients about the relative importance of different medical device characteristics. Different groups of healthcare professionals involved with the provision of medical devices were included (doctors, nurses, pharmacists) as well as medical device users and non-users. The results showed that practical factors (user testing, clear instructions, clinical trials, reducing appointments, training and cost effectiveness) are viewed as more important by professional groups than factors that relate to the home environment (choice and appearance). This indicates a lack of a whole person approach to patient care and the selection of home medical devices. In the third study longitudinal interviews were carried out with four couples, where one of the couple had been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and prescribed an oxygen concentrator to use at home. The aim of this study was to discover how couples experience the process of being given a medical device to use at home over time. The interviews identified that being given an oxygen concentrator can be the source of an acute episode of uncertainty for some couples and the process of coping was mediated by the expectations that they had prior to being given the device. This research has provided a valuable insight into the poorly understood impact that medical devices have on people’s experience of the home environment.
... Results of our study add to a broader context of the role of relationships in OSA and CPAP use as well as the role of gender in OSA treatment. The symptoms of OSA, including snoring, daytime sleepiness, and depressed mood, affect both patient and partner quality of life (Doherty et al. 2003;Reishtein et al. 2006;Cartwright 2008;Cartwright and Knight 1987;Baron et al. 2009). In male participants, relationship conflict was associated with poorer adherence and collaborative involvement from the spouse was associated with higher adherence (Baron et al. 2009(Baron et al. , 2011. ...
Article
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Background Obstructive sleep apnea contributes to daytime sleepiness, poor quality of life and increased risk for heart disease and hypertension among women. Continuous positive airway pressure improves sleepiness and quality of life and may reduce health risks but few studies have evaluated predictors of adherence among women. The goal of this study was to evaluate the role of relationship factors in women’s continuous positive airway pressure (CPAP) adherence and change in relationship quality among married/partnered women.
... Older age (Budhiraja et al., 2007; Woehrle, Graml, & Weinreich, 2011) and being male (Joo & Herdegen, 2007) are often related to adherence, although at odds (Lewis, Seale, Bartle, Watkins, & Ebden, 2004). Even though the marital status does not predict adherence (Sucena, Liistro, Aubert, Rodenstein, & Pieters, 2006), it seems to justify significant differences in a way of better adherence (Cartwright, 2008). An elevated basal (Apnoea Hypopnoea Index) AHI predicts adherence, at one and three months and CPAP treatment (Hui et al., 2001). ...
Article
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Adherence is still an important issue considering new advances in Obstructive Sleep Apnea (OSA) treatment, as automatic positive airway pressure (APAP). The aim of the present study was to identify and explore relationships between identified predictors of adherence, over time. After overnight sleep study and OSA diagnosis and during a six-month APAP treatment period, a total of 153 patients underwent a three time psychological protocol evaluation. Generalized estimating equations were applied to analyzed repeated measurements in the same individuals. Results show that 40% of patients were poorly adherent and 60% were adherent after six months of treatment. The results confirmed a predictive value of age, self-efficacy, decisional balance index and health-related quality of life (HRQoL) in APAP adherence. Furthermore, the results revealed an interaction between time and illness cognitive representations, and self-efficacy and family coping, in explaining adherence patterns over time. Therefore, understanding the causality of theoretically derived constructs is crucial to predict the continuity of APAP adherence.
Article
Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low. The partner has an important role in supporting the patient, but this role may be adversely affected by difficulties during the early phase of the CPAP initiation. The aim of this study was to explore and describe decisive situations affecting partners' support to patients with OSAS and how the partners manage these situations during the initial phase of CPAP treatment. A qualitative descriptive design using critical incident technique was used. A total of 542 decisive situations affecting partners' support and 222 situations describing managing were collected by means of interviews with 25 strategically selected partners of patients with CPAP treated OSAS. Adverse effects, limited effect, practical and psychosocial problems, limited presence, and inappropriate initiation emerged as negative influences on the partners' support. A well-functioning treatment, improvements, high motivation, and receiving support from others were identified as positive influences on the partners' support. The partner managed the situations by letting the patient handle the CPAP treatment by himself/herself, by handling the treatment together with the patient, or taking over the handling of CPAP treatment. Increased knowledge about the different situations that affect the partners' support negatively or positively and how these situations are managed by partners can be used in educational situations involving both patients and partners during CPAP initiation.
Article
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This doctoral project seeks to answer the question about the essence of functioning, disability and health in the lived experience of persons with any kind of primary sleep disorder. Its overall objective is the development of a first version of Core Sets of categories of the International Classification of Functioning, Disability and Health (ICF) in an evidence- and consensus-based process. To this end, four separate studies exploring different perspectives (researcher, clinical, patient, health professional) have been conducted and their results provided the evidence basis for selecting the relevant categories for the ICF Core Sets for Sleep Disorders during an international consensus conference. The doctoral thesis first-authored by the doctoral candidate therefore consists of five separate publications (1 Systematic Review, 2 Patient Studies, 1 Expert Survey, 1 Conference Results) that describe the different steps in the development process.
Article
Objectives This study aimed to explore the unique experiences of people with obstructive sleep apnoea (OSA) who source their treatment through community pharmacies. Methods A qualitative study employing the phenomenological approach was used. In-depth semi-structured interviews with a purposive convenience sample of 20 participants were conducted. Twenty participants were recruited from community pharmacies offering continuous positive airways pressure (CPAP) device provision and a teaching hospital in Sydney, Australia. Interviews were digitally recorded and transcribed verbatim, coded using Nvivo8 software and analysed based on the ‘framework’ method. Key findings The quality and delivery of information at diagnosis was reported to have been inappropriate for participants' personal needs. Many barriers emerged in regards to CPAP use, consistent with current literature. Participants' self-reported individual styles, coping practices and health beliefs appeared to be the most influential factors in CPAP uptake and adherence, regardless of mechanical advancements and environmental support. High satisfaction was expressed with CPAP obtainment from pharmacy services listing convenience and good service as notable characteristics. Conclusions Community pharmacies have the potential to increase OSA awareness and improve optimal usage of CPAP. Psychosocial based models of adherence intervention could potentially be implemented through CPAP providers, including the community pharmacy, to address some of these factors which impede CPAP adherence.
Article
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Positive pressure ventilation is considered first line therapy in obstructive sleep apnea syndrome however compliance is limited by various factors. We aimed to investigate possible factors influencing compliance. One hundred and forty patients were prescribed positive pressure ventilation for obstructive sleep apnea during June 2006-June 2008. Of these patients, 77% (n= 108) were reached by telephone and a questionnaire was administered regarding factors influencing treatment compliance. Airway passage was measured with C2 vertebrae level and narrowest airway passage on lateral skull radiographs. The mean age was 52.2 ± 12.3 years. Seventy one percent (n= 77) of subjects obtained the prescribed device. There was no difference in sex, age, marital status, educational level, symptoms, co-morbid conditions, and social security coverage between the subjects who have received the prescribed devices and who have not (p> 0.05). No difference was detected between these two groups of patients in view of Epworth sleepiness scale (ESS) and apnea hypopnea index (AHI). Mean duration of device usage was 6.3 ± 2.3 hours. The device use compliance was not affected by any of the following factors: age, gender, level of education, co-morbid diseases, ESS score, AHI, airway passage measurements, application of humidification and education concerning the device (p> 0.05). Patient (p= 0.057) and bed partners (p= 0.001) satisfaction about the device yielded higher compliance rates. Factors influencing compliance rates in obstructive sleep apnea syndrome seems to be related to satisfaction about the device use however upper airway morphology measured with C2 vertebrae level and narrowest airway passage has no impact on treatment compliance.
Chapter
This chapter reviews “soft” or nonmechanical methods of continuous positive airway pressure (CPAP) adherence in obstructive sleep apnea (OSA). Much of the data are conflicting partly because the studies describe variable OSA populations, but predictive demographic, psychological, and social variables and personality factors and key comorbidities are outlined in a clinically relevant fashion. Decision-making about whether or when to integrate CPAP into the patient’s treatment plan given these factors is discussed. The evidence for behavioral, supportive, and educational interventions for CPAP adherence is summarized with practical implementation strategies. The limited data in children and adolescent CPAP adherence will also be reviewed. Integration of these approaches into telemedicine and emerging technology to improve CPAP adherence will be summarized. This is critical given the current shift in medical service delivery to remote methods of care owing to both the current pandemic and exponential technological growth. The chapter will conclude with models to conceptualize the multifactorial and interactive nature of CPAP adherence.
Article
Background: CPAP is considered to be the cornerstone of therapy for obstructive sleep apnea. However, adherence to this treatment is frequently poor, which may lead to ongoing symptoms, including daytime sleepiness and poor cognitive function. We aimed to determine the efficacy of showing patients their raw graphic polysomnography (PSG) data in increasing their CPAP adherence. Methods: The subjects were patients with obstructive sleep apnea (n = 37, diagnosed on prior PSG), who were prospectively randomized into an experimental arm or a control arm. The patients in the experimental arm (n = 18) were shown detailed PSG data, including graphic data from PSG prior to prescription of CPAP. The patients in the control arm (n = 19) were shown the non-graphic paper report of the PSG. Adherence data, collected using CPAP devices with internal microprocessors (adherence cards), was read at 4 weeks after treatment initiation. Results: There was no difference in age (57.3 ± 11.8 y vs 55.5 ± 11.6 y, P = .64), body mass index (BMI) (32.7 ± 6.3 kg/m(2) vs 32.3 ± 6.6 kg/m(2), P = .85), and apnea-hypopnea index (36.0 ± 27.8 events/h vs 30.5 ± 19.1 events/h, P = .48) between the experimental and control arms. There was no difference in percent of days CPAP was used (58% vs 64%, P = .59) and average number of hours each night CPAP was used (3.9 ± 2.1 h vs 4.1 ± 2.5 h, P = .76) between the experimental and control arms, respectively. In multi logistic regression models, which included age, BMI > 30 kg/m(2), apnea-hypopnea index, and experimental intervention, only BMI was found to increase likelihood of improved adherence (odds ratio = 13.3, P = .007). Conclusions: Showing patients raw graphic PSG data does not seem to improve adherence to CPAP. BMI is a very strong predictor of CPAP adherence.
Article
Since the invention of dextri-maltose and the subsequent rise of Similac in the early twentieth century, parents with access to clean drinking water have had a safe alternative to breast-milk. Use of formula spiked between the 1950s and 1970s, with some reports showing that nearly 75 percent of the population relied on commercial formula to at least supplement a breastfeeding routine. So how is it that most of those bottle-fed babies grew up to believe that breast, and only breast, is best? In Is Breast Best? Joan B. Wolf challenges the widespread belief that breastfeeding is medically superior to bottle-feeding. Despite the fact that breastfeeding has become the ultimate expression of maternal dedication, Wolf writes, the conviction that breastfeeding provides babies unique health benefits and that formula feeding is a risky substitute is unsubstantiated by the evidence. In accessible prose, Wolf argues that a public obsession with health and what she calls "total motherhood" has made breastfeeding a cause célèbre, and that public discussions of breastfeeding say more about infatuation with personal responsibility and perfect mothering in America than they do about the concrete benefits of the breast. Why has breastfeeding re-asserted itself over the last twenty years, and why are the government, the scientific and medical communities, and so many mothers so invested in the idea? Parsing the rhetoric of expert advice, including the recent National Breastfeeding Awareness Campaign, and rigorously questioning the scientific evidence, Wolf uncovers a path by which a mother can feel informed and confident about how best to feed her thriving infant-whether flourishing by breast or by bottle.
Article
Although continuous positive airway pressure (CPAP) is highly efficacious in the elimination of nocturnal apneas and hypopneas of obstructive sleep apnea (OSA), suboptimal adherence to treatment is common. Investigations of CPAP adherence reveal frequent adverse effects, and weak relationships between personality factors, OSA severity, symptoms, and CPAP use. Several well-conducted studies of mechanical interventions to overcome CPAP disadvantages have reported success; however, corresponding increase in adherence is not proportional to the reduction in adverse effects. Psychoeducational approaches provide promise for improving adherence, but are currently less rigorously evaluated. As appreciation for behavioral factors and technology increases, additional research is needed to identify which factors, in combination with mechanical interventions, provide the best prescription for CPAP adherence.
Article
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Objective: Early prediction of which patients with obstructive sleep apnea will not adhere with CPAP can trigger physicians to correct possible causes or offer alternative therapies. This study aims to determine the ability of early CPAP use to predict long-term adherence with CPAP independent from its definition and to test previously described predictors of adherence. Method: This is a prospective, observational cohort study that was performed in nine sleep disorder centers in France. Patients were newly diagnosed with obstructive sleep apnea and a CPAP was prescribed for the first time. We collected socioeconomic, medical, sleep, and psychological variables to be associated with adherence with CPAP. The patients were evaluated 15 days after CPAP set up and monthly for 4 months until they were adherent. We assessed potential predictors of CPAP adherence at 4 months with emphasis on CPAP use at 15 days. CPAP adherence was defined as an average daily use of at least 3, 4, 5, and 6 hours. Results: We enrolled 420 patients. Early CPAP use and CPAP use at 4 months were similar. At 4 months, 94% of patients used a CPAP ≥3 hours and 49% of patients used it ≥6 hours. The area under the ROC curve for early CPAP use predicting adherence at 4 months was ≥0.85 for all adherence definitions. The optimal threshold for early CPAP use to predict adherence increased from 3.2 to 6.4 hours as the definition of CPAP adherence increased from 3 to 6 hours. CPAP use at 4 months was higher in older patients. Conclusions: Early CPAP use was the single best predictor of CPAP adherence and was independent of how adherence was defined. Physicians must assess CPAP use no later than 2 weeks to address its causes or prescribe an alternative therapy.
Chapter
Das obstruktive Schlafapnoesyndrom stellt einen der wichtigsten kardiovaskulären Risikofaktoren dar. Umgekehrt wird die zentrale Schlafapnoe häufig durch kardiologische, nephrologische oder neurologische Erkrankungen oder pharmakologische Einflüsse ausgelöst. Beim Zusammentreffen von Herzerkrankungen und Atmungsstörungen wird die Prognose ungünstig beeinflusst. Das obstruktive Schlafapnoesyndrom wird durch morphologische und funktionelle Einengungen der oberen Atemwege wesentlich bedingt. Demgegenüber liegt der zentralen Schlafapnoe eine Störung der Atmungsregulation zugrunde. Die Leitsymptome des obstruktiven Schlafapnoesyndroms sind lautes, oft unregelmäßiges Schnarchen, fremdbeobachtete Atempausen und eine vermehrte Tagesschläfrigkeit. Weiterführende Untersuchungsverfahren sollen das Krankheitsbild nachweisen und seine Auswirkungen, insbesondere auf die Vigilanz, erfassen. Dazu dienen Fragebögen, Aufmerksamkeitstests sowie nächtliche Untersuchungen des Schlafes und kardiorespiratorischer Parameter. Bei Patienten mit kardiovaskulären Erkrankungen sollten Screeninguntersuchungen auf schlafbezogene Atmungsstörungen erwogen werden. Die Polysomnographie stellt den diagnostischen Goldstandard in der Schlafmedizin dar. Die Therapie des obstruktiven Schlafapnoesyndroms wird durch die klinische Symptomatik bestimmt, insbesondere durch die Einschränkung der neurokognitiven Leistungsfähigkeit, durch die Tagesschläfrigkeit, der durch die Unfallgefährdung, durch kardiovaskuläre Begleiterkrankungen sowie den Schweregrad der Erkrankung. Therapiestandard ist das Positivdruckverfahren (CPAP). Bei CPAP-Intoleranz kann eine Protrusionsschiene indiziert sein.
Article
Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders in the United Sates and is a risk factor for poor health outcomes. Continuous positive airway pressure (CPAP) therapy is an effective treatment for OSA, but adherence rates are poor. Although the spouses of patients with OSA have high potential to influence adherence, there has been minimal research to date. The purpose of this review is to summarize key findings regarding spousal influence on health-related behavior change and treatment adherence from other medical fields (e.g., type 2 diabetes and cardiovascular disease) in which this line of inquiry has been more thoroughly developed. Recommendations are presented to guide future research investigating spousal influence on CPAP adherence based on findings from other patient populations. In particular, we emphasize the use of spousal health-related social control as it applies to adherence and provide guidance regarding conceptual and methodological moderators.
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Continuous positive airway pressure (CPAP) is the gold standard of treatment for patients diagnosed with significant Obstructive Sleep Apnea (OSA). Although CPAP is highly effective in preventing the repetitive upper airway collapses in OSA, compliance to treatment is poor, which in turn leads to poorer health outcomes. In this study an extensive review of the literature was completed using the Cochrane library, CINAHL, PubMed and Embase databases. The research objective of this study was to determine the efficacy of interventions designed to increase compliance with CPAP. The themes that were found to be effective in increasing compliance with CPAP were increased patient education and intensive patient support. Improvements in CPAP compliance will positive impact patients, patient’s families and the health care system. In conclusion, the evidence points to the necessity of implementation of an intensive patient education and patient support program for all OSA patients.
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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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Abstract Objective Obstructive sleep apnea (OSA) is a common condition with numerous health and psychological consequences. While treatment with Continuous Positive Airway Pressure (CPAP) is highly effective, it seems to be impacted by interpersonal aspects of the patient. The current study explores the role of two major interpersonal descriptors (attachment and relationship satisfaction) on treatment initiation and compliance with CPAP. The benefit of CPAP treatment on sleep measures and psychological functioning is also examined. Methods Participants in stable relationships, diagnosed with OSA following an inpatient polysomnography test (N = 83), were recruited. Participants were appraised on their decision to initiate treatment and completed interpersonal measures (couples' satisfaction, attachment dimensions) as well as sleep measures and mental health measures. Participants were invited to repeat the measures after 3 months (N = 31 agreed). Associations between interpersonal measures and CPAP initiation and compliance as well as the impact of CPAP on sleep and all psychological measures was assessed. Results Individuals with high attachment anxiety pursued OSA treatment based on a mutual decision with the partner, while individuals with lower attachment anxiety made the decision themselves. Couples' satisfaction was positively associated with CPAP compliance over 3 months. CPAP compliance significantly improved sleep measures, mood and anxiety symptoms. Conclusion The study brings evidence for a positive role of interpersonal factors in the initiation and compliance with OSA treatment as well as longitudinal benefits on sleep, mood and anxiety levels. The results can inform clinical approaches meant to increase treatment engagement and adherence in OSA patients through psychoeducation.
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The objective of this systematic review and content analysis was to identify and quantify the concepts contained in patient-administered health status measures in sleep medicine practice and research using the International Classification of Functioning, Disability and Health (ICF) as a reference. Both generic and condition-specific patient-administered measures/questionnaires used in sleep medicine practice and research were identified and selected. A comprehensive search strategy for reviews, National/International Guidelines and Standard References to ensure that all areas of functioning, disability and health were captured was used. The contents of the selected measures were examined and linked to the ICF using established linking rules. The frequencies of ICF categories covering the concepts contained in the 115 patient-administered measures were used for the descriptive analysis and content comparison. Of these, 35 were of a generic nature, 17 were symptom-related, and 63 condition-specific. The concepts identified in the questionnaires' items were predominantly linked to categories of the ICF component related to body functions (61.4%), followed by activities and participation (15.3%), and then environmental factors (9.8%). The measures vary greatly with regard to the number and specificity of the ICF categories covered, as indicated by the proportional indices of content density and content diversity. The ICF provides a useful reference to identify, quantify and compare the concepts contained in health status measures used in sleep medicine practice and research.
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The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
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Continuous positive airway pressure (CPAP) improves daytime sleepiness and quality of life in patients with obstructive sleep apnea syndrome (OSAS). However, few studies have examined the impact of treatment on the quality of life of bed partners of these patients. We prospectively studied 55 couples in which one person (the patient) had OSAS diagnosed and was subsequently commenced on CPAP therapy; 45 of these couples shared a bed on a regular basis. Both partner and patient completed postal questionnaires immediately prior to CPAP therapy and again after a median of 8 weeks (interquartile range [IQR], 6 to 12 weeks) of therapy at home. Questionnaires consisted of the Epworth sleepiness scale (ESS), the UK Short Form-36 health survey, and the hospital anxiety and depression scale. No intervention or advice was given to the partner of the patient receiving CPAP therapy. In addition to the expected significant benefits reported by patients receiving CPAP, bed partners also reported significant improvements in ESS scores (median, 4 [IQR, 1 to 8.5] before CPAP; median, 2 [IQR, 1 to 5] during CPAP), in addition to measures of anxiety, role limitation due to physical problems, role limitation due to emotional problems, social functioning, mental health, and energy/vitality (all p < 0.05 by Wilcoxon-signed rank testing). These data support the hypothesis that partners of patients with OSAS benefit significantly from the CPAP therapy their bed partners receive.
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To compare adherence and clinical outcomes between flexible positive airway pressure (PAP) [C-Flex; Respironics; Murraysville, PA] and standard PAP therapy (ie, continuous positive airway pressure [CPAP]). A controlled clinical trial of CPAP therapy vs therapy using the C-Flex device in participants with moderate-to-severe obstructive sleep apnea. Participants were recruited from and followed up through an academic sleep disorders center. Eighty-nine participants were recruited into the study after they had undergone complete in-laboratory polysomnography and before initiating therapy. Participants received either therapy with CPAP (n = 41) or with the C-Flex device (n = 48), depending on the available treatment at the time of recruitment, with those recruited earlier receiving CPAP therapy and those recruited later receiving therapy with the C-Flex device. Follow-up assessments were conducted at 3 months. The groups were similar demographically. The mean (+/- SD) treatment adherence over the 3-month follow-up period was higher in the C-Flex group compared to the CPAP group (weeks 2 to 4, 4.2 +/- 2.4 vs 3.5 +/- 2.8, respectively; weeks 9 to 12, 4.8 +/- 2.4 vs 3.1 +/- 2.8, respectively). Clinical outcomes and attitudes toward treatment (self-efficacy) were also measured. Change in subjective sleepiness and functional outcomes associated with sleep did not improve more in one group over the other. Self-efficacy showed a trend toward being higher at the follow-up in those patients who had been treated with the C-Flex device compared to CPAP treatment. Therapy with the C-Flex device may improve overall adherence over 3 months compared to standard therapy with CPAP. Clinical outcomes do not improve consistently, but C-Flex users may be more confident about their ability to adhere to treatment. Randomized clinical trials are needed to replicate these findings.
Article
Two related studies are reported. Both involved the use of wrist actimetry and morning sleep logs in subjects 23-67 years of age. In the first study, 46 pairs of bed partners were monitored for 8 nights to assess the extent and concordance of their body movements, and whether the latter exhibited age and gender differences. The second study concentrated on the presence or absence of a bed partner, and included subjects who either habitually slept alone or whose usual partner was absent for at least 1 night. Men showed a significantly greater number of discrete movements during sleep than did women. Overall, 5-6% of all 30-second sleep epochs contained such movements, with about 1/3 of these movements being common (within the same epoch) to both partners. This concordance was highest in younger couples. Female bed partners reported being disturbed more often by their partner than was the case for male partners. Subjects sleeping with a partner showed a greater number of discrete movements than matched subjects who slept alone. Movements decreased during temporary absence of the usual bed partner. Couples seemed unaware of the similarity in the timing of their movements during sleep, and most reported sleeping better when their bed partner was present.
Obstruction of the upper airway during sleep (OSAS) is widely treated by having patients self-administer nasal continuous positive airway pressure (CPAP). To obtain objective evidence of the patterns of CPAP use, information was gathered from two urban sites on 35 OSAS patients who were prescribed CPAP for a total of 3,743 days. Patients were given CPAP machines that contained a microprocessor and monitor that measured actual pressure at the mask for every minute of each 24-h day for an average of 106 days per patient. They were not aware of the monitor inside the CPAP machines. Monitor output was compared with patients' diagnostic status, pretreatment clinical and demographic characteristics, and follow-up self-reports of CPAP use, problems, side effects, and aspects of daytime fatigue and sleepiness. Patients attempted to use CPAP an average of 66 +/- 37% of the days monitored. When CPAP was used, the mean duration of use was 4.88 +/- 1.97 h. However, patients' reports of the duration of CPAP use overestimated actual use by 69 +/- 110 min (p < 0.002). Both frequency and duration of CPAP use in the first month reliably predicted use in the third month (p < 0.0001). Although the majority (60%) of patients claimed to use CPAP nightly, only 16 of 35 (46%) met criteria for regular use, defined by at least 4 h of CPAP administered on 70% of the days monitored. Relative to less regular users, these 16 patients had more years of education (p = 0.05), and were more likely to work in professional occupations.(ABSTRACT TRUNCATED AT 250 WORDS)
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The Calgary Sleep Apnea Quality of Life Index (SAQLI) was developed to record key elements of the disease that are important to patients. All items felt to influence the quality of life of these patients were identified. Final questionnaire items were selected by interviewing 113 patients with sleep apnea and 50 snorers who rated each item on whether it was a problem and the importance of it to their overall quality of life. Items for the final questionnaire were selected based on the rank order of the frequency ximportance product. The rank ordering was similar across strata of disease severity and between sexes. The Calgary SAQLI has 35 questions organized into four domains: daily functioning, social interactions, emotional functioning, and symptoms. A fifth domain, treatment-related symptoms, can be added for clinical intervention trials to record the possible negative impacts of treatment. The SAQLI has a high degree of internal consistency, face validity as judged by content experts and patients, and construct validity as shown by its positive correlations with the SF-36 and the improvement in scores in patients successfully completing a 4-wk trial of continuous positive airway pressure. It includes items shown to be important to patients with sleep apnea and is designed as a measure of outcome in clinical trials in sleep apnea. Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea.
Article
Women living with heavy snorers were more frequently affected by symptoms of insomnia, morning headache, daytime sleepiness, and fatigue than women living with non-snorers. Questionnaire data were collected from 1,032 women 30 to 64 years of age residing in Dalarna county, in mid-Sweden. There were indications of a "dose-response relationship" between the conjectured sound exposure and reported symptoms, regardless of whether the female herself snored. Sleeping in separate bedrooms did not seem to give the women any alleviation. The results point to a possible contributory cause of disturbed sleep, morning headache, and daytime sleepiness among women living with a snoring spouse. The results also indicate that prevention and treatment of snoring are important issues for the couple as well as for the snorer.
Article
To measure the effect of snoring and obstructive sleep apnea (OSA) on the sleep of snorers' bed partners and to determine whether a bed partner's sleep improves when snoring and OSA are treated. We studied 10 married couples in which 1 member was undergoing polysomnography to evaluate suspected OSA. The patients and their spouses underwent simultaneous polysomnography. Midway through the 1-night study, the patients received nasal continuous positive airway pressure (CPAP) with the pressure adjusted to eliminate snoring and obstructive breathing events. Apnea-hypopnea index (episodes/hours of sleep time), arousal index (arousals/hours of sleep time), and sleep efficiency (percent time asleep) were calculated to measure sleep quality. The patients (all male) demonstrated a median (range) apnea-hypopnea index of 26 (3-75) that decreased to 7 (0-34) during the trial of nasal CPAP therapy (P < .05). During the CPAP trial, the median (range) arousal index of the spouses decreased from 21 (14-34) to 12 (4-27) (P < .01), and the spouses' median (range) sleep efficiency increased from 74% (56%-80%) to 87% (64%-95%) (P < .01). The elimination of snoring and OSA in these patients was associated with an improvement in the quality of their bed partners' sleep, as indicated by improved sleep efficiency and continuity, even when the spouses had been habitually exposed to snoring and OSA. Assuming that 480 minutes were spent in bed for sleep, a 13% improvement in sleep efficiency (i.e., from 74% to 87%) translates to an additional 62 minutes of sleep per night for the spouses of snorers with OSA.
Article
The sleep apnoea/hypopnoea syndrome (SAHS) causes snoring, apnoeas, and restlessness during sleep which partners frequently complain about. A study was undertaken to determine the impact on partners of SAHS and of treatment of the patient with continuous positive airway pressure (CPAP). Forty nine partners and patients with SAHS booked for CPAP treatment completed in house and validated questionnaires (Pittsburgh sleep quality index, Short Form 36 self-reported health status) before the patient started treatment. Twenty three couples in whom the index SAHS patient had no driving problems were recruited to a randomised crossover trial with 1 month limbs of CPAP and placebo capsule. At the end of each limb the partners' sleep was monitored by home polysomnography (PSG) and questionnaires were completed. Before treatment partners frequently reported moderate to severe disturbance from patient snoring/apnoeas/restlessness and had poor sleep quality and self-reported health status. In the crossover study (22 completed) the partners' objective sleep quality did not differ between CPAP and placebo, but they reported benefit from treatment of the patients with CPAP in subjective sleep quality (p=0.05) and disturbance to sleep (p=0.03). The reported change in partners' sleep quality between pre-study and following CPAP treatment correlated positively with CPAP use (r=0.5, p=0.01). Partners of patients with SAHS have poor sleep quality and self-reported health status but only subjective sleep quality benefits from treatment of the patient with CPAP.
Article
Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority.
Article
Though continuous positive airway pressure (CPAP) is the treatment of choice for the sleep apnoea/hypopnoea syndrome (SAHS), suboptimal adherence to CPAP is common. Internationally, some 5-50% of SAHS patients recommended for CPAP either reject this treatment option or discontinue within the first week, and 12-25% of remaining patients can be expected to have discontinued CPAP by 3 years. Biomedical investigations of patients' CPAP use reveal frequent adverse effects, weak prospective relationships between symptomatic or physiological disease severity and CPAP use, and moderate correlations between use and benefit. Relatively expensive high-technological interventions to improve CPAP use (e.g. "intelligent" CPAP, humidification) are the subject of several well-conducted studies favouring their effectiveness. More basic educational and behavioural supports, and low-technological interventions (e.g. chinstraps, mask re-fitting) appear valued, but are currently less rigorously evaluated. In other diseases with demanding treatment regimens, cognitive constructs including health attitudes and beliefs (health value, locus of control, chance, powerful others, self-efficacy) and mental and physical health status are significant predictors of adherence. The enhancement of multidisciplinary models with psychosocial interpretations may provide increased explanatory and interventional potential in models of CPAP use. While acknowledging the scarcity of evidence, a structured, multidisciplinary, cost-efficient model is suggested, containing educational, behavioural and technological components as basic support, and with high-expertise cognitive-behavioural intervention in more difficult cases of low CPAP use.
Article
Obstructive sleep apnea is a prevalent condition with potentially serious medical and psychosocial consequences. Nasal continuous positive airway pressure (CPAP) is the treatment-of-choice and has been shown to reduce the frequency of nocturnal respiratory events, improve sleep architecture and decrease daytime sleepiness. Patient compliance with CPAP is disappointingly low. Previous studies examining determinants of CPAP compliance have limited the variables studied to patient (sociodemographic), disease status, and treatment variables, with few reliable determinants found. The purpose of the current study was to investigate the relationship between objectively measured CPAP compliance and variables from social cognitive theory (SCT) and the transtheoretical model (TM). Scales that measure variables from each model were developed and reliability evaluated. The relationship between the SCT and TM variables and compliance at 1-month post-CPAP-fitting was prospectively evaluated on 51 first-time CPAP users. SCT and TM variables were measured on the day of CPAP-fitting, at 1-week post-CPAP-fitting, and at 1-month post-CPAP-fitting. SCT variables measured 1-week post-CPAP-fitting (R(2)=0.261, P=0.001) and TM variables measured 1-week post-CPAP-fitting (R(2)=0.17, P=0.002) accounted for a statistically significant amount of variance in objective CPAP compliance measured at 1 month. The decisional balance index (from TM) individually accounted for a significant amount of variance in objective CPAP compliance in the above analyses. The ability of these new behavior change scales to predict CPAP compliance provides us with a new direction of research to better understand factors associated with compliance. The principal advantage of these theory-driven and empirically validated scales are that they measure modifiable factors that can provide the basis for sound interventions to improve CPAP compliance.
Article
Obstructive sleep apnea (OSA) has been shown to affect the quality of life (QOL) in patients, and QOL improves after treatment with nasal continuous positive airway pressure (CPAP). However, the effects on the bed partner of the patient with OSA have received little attention. We studied QOL in patients with OSA and their bed partners, and the effect of CPAP therapy on QOL. Fifty-four patients and their bed partners who had been seen for evaluation of OSA, had undergone polysomnography, and subsequently had received treatment with CPAP. Patients and bed partners completed the Epworth sleepiness scale (ESS) and QOL questionnaires before and after the patients' therapy. Sleep disorders center in an academic medical center. Patients with documented OSA and regular bed partners. Both individuals completed the 36-item short-form health survey (SF-36), the ESS, and the Calgary sleep apnea quality of life index (SAQLI). At about 6 weeks after CPAP therapy, patients and their bed partners completed the same set of questionnaires again. Of the 54 subjects who completed the study, the mean (+/- SD) apnea-hypopnea index was 48.4 +/- 33.3. For the subjects, the mean ESS decreased from 12.9 +/- 4.4 to 7.3 +/- 4.0 (p < 0.001) after treatment with CPAP. For the bed partners, the mean ESS decreased from 7.4 +/- 6.1 to 5.8 +/- 4.7 (p = 0.02). The mean scores on the SAQLI were 4.1 +/- 1.0 for the subjects and 4.5 +/- 1.3 for the bed partners. Following CPAP therapy, the SAQLI increased in the subjects to 4.9 +/- 1.2 (p < 0.001), and in the bed partners to 5.1 +/- 0.9 (p = 0.002). The SF-36 showed positive changes in both the subjects and the bed partners. Significant improvements were observed in the subjects in role-physical, vitality, social functioning, role-emotional, and mental health domains. In the bed partners, significant changes in the SF-36 were observed in role-physical, vitality, social functioning, and mental health domains. OSA results in impaired QOL in both the patients and their bed partners. Treatment with CPAP improves QOL, as measured by the SF-36 and the SAQLI.