The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment (original) (raw)
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J Sleep Res, 2010
Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and CronbachÕs alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment. k e y w o r d s adherence, attitudes, continuous positive airway pressure, obstructive sleep apnoea syndrome, reliability, validity
Journal of Clinical Sleep Medicine, 2010
Background: The reasons that a patient has to start treatment, their "Cues to Action," are important for determining subsequent health behaviors. Cues to action are an explicit component of the Health Belief Model of continuous positive airway pressure (CPAP) acceptance. At present, there is no scale available to measure this construct for individuals with obstructive sleep apnea (OSA). This paper aims to develop, validate, and describe responding patterns within a sample of patients with OSA to the Cues to CPAP Use Questionnaire (CCUQ). Method: Participants were 63 adult patients diagnosed with OSA who had never tried CPAP when initially recruited. The CCUQ was completed at 1 month after being prescribed CPAP. Results: Exploratory factor analysis (EFA) showed a 3-factor structure of the 9-item CCUQ, with "Health Cues," "Partner Cues," and "Health Professional Cues" subscales accounting for 59.91% of the total variance. The CCUQ demonstrated modest internal consistency and split-half reliability. The questionnaire is brief and user friendly, with readability at a seventh-grade level. The most frequently endorsed cues for starting CPAP were Health Professional Cues (prompting by the sleep physician) and Health Cues such as tiredness and concern about health outcomes. Conclusions: This study validates a measure of an important motivational component of the Health Belief Model. Health Professional Cues and internal Health Cues were reported to be the most important prompts to commence CPAP by this patient sample.
Sleep Medicine, 2006
Background: Many patients abandon continuous positive airway pressure (CPAP) treatment after initial acceptance. This may be for physical or psychological reasons. Methods: We have carried out semi-structured interviews, constructed from the Health Belief Model (HBM) with a convenience sample of patients who had recently abandoned CPAP treatment after at least 6 months of use. We explored their understanding and experiences of their OSA and of the CPAP therapy and their reasons for stopping treatment. Results: Nine patients were interviewed (age 32-70 years; 8 males). Four patients were not clear about the nature, severity, or consequences of sleep apnoea syndrome (SAS) and did not consider themselves to be ill. Three expected to be cured by the machine. Only one patient spoke of life-threatening risk. Eight of the nine patients had other health disorders. Seven stopped CPAP because of negative experiences, including problems with the mask and noise from the machine. Two patients felt 'liberated' on stopping treatment. Conclusions: Studies at the initiation stage of CPAP treatment are needed in order to identify factors impeding acceptance, which can be addressed early. The Health Belief Model, which emphasises subjective health experience and patients' beliefs about treatment, may be a useful tool for such investigations.
Can psychological factors help us to determine adherence to CPAP? A prospective study
European Respiratory Journal, 2004
The present study objective was to establish whether pretreatment social cognitive variables may contribute to the explanation of variance in adherence to continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). A total of 119 of 180 consecutive OSAHS patients were recruited to the study prior to initial CPAP titration. Patients completed psychological measures of health value, health locus of control (incorporating internality, chance, powerful others) and selfefficacy prior to CPAP titration. Objective adherence data were measured by CPAP unit time clocks and collected at 3-month follow-up. Average nightly use was calculated over this period. Logistic regression of prospective predictors of adherence produced a model comprising psychological (health value, internality, powerful others), as well as clinical variables (Epworth score, body mass index, apnoea/hypopnoea index, CPAP pressure). This model explained 24% of the variance in CPAP use, and correctly identified 75% of adherers and 53% of nonadherers. Although the psychological variables explained only a small amount of the overall variance in adherence behaviour, this result provides further support for the hypothesis that psychological variables contribute, in part, to continuous positive airway pressure adherence. Future research should focus on highlighting discrete variables, which may helpfully inform psychologically based interventions aimed at improving the use of continuous positive airway pressure by patients with obstructive sleep apnoea/ hypopnoea syndrome at risk of discontinuance.
Respiratory Medicine, 2013
Introduction: It is important to identify those patients with OSA who are likely to benefit from long term CPAP, not only for symptomatic relief, but also potentially to reduce vascular morbidity and mortality, but are unlikely to adhere to treatment. We have validated a model which we developed previously for predicting long term compliance with CPAP using data after a 2 week trial. Methods: The model was applied retrospectively to patients undergoing a trial of CPAP. Predicted outcomes were compared with the actual outcomes. Results: Prediction equation was applied to 448 patients [77% males, Age 53 AE 11 years, ESS 14 AE 4, AHI 37 AE 24]. Of 407 patients included in the study 333 were issued a CPAP and 74 declined long term CPAP. At one year, 81% patients were using CPAP at least 2 h and 70% > 4 h. A score >50% from the equation was associated with a high probability of CPAP usage at one year. 295 patients had a probability score of >50% and of them 84% were using CPAP satisfactorily at 1 year. The sensitivity in identifying compliers was 91%. Of the 112 patients with a score 50%, 38 opted to accept CPAP and 60% of them were still using it at 1 year. Conclusions: This simple equation has now been validated to be highly sensitive in identifying long term compliers and it also identifies those with worse compliance. This group could be targeted for a more intensive follow up regime with the aim of improving their compliance.
Sleep and Breathing, 2012
The aim of the study was to asses quality of life and symptoms of obstructive sleep apnea syndrome (OSAS) patients after adhering to 6 months of continuous positive airway pressure (CPAP) treatment. Methods A group of 50 patients (41 men and 9 women) were diagnosed by polysomnography and treated with CPAP therapy for 6 months. Their symptoms and healthrelated quality of life were assessed by administering a validated and translated version of the sleep apnea quality of life index (SAQLI). Sleepiness was measured using the Epworth Sleepiness Scale (ESS) and through electronic monitoring of CPAP usage per night of sleep. Results Mean CPAP usage was 4.5±0.5 h per night. Comparisons between quality of life indexes before and after CPAP treatment showed an improvement in the total SAQLI score (3.8±0.9 vs. 5.8±0.8 after CPAP, p<0.01), in daily functioning (4.2±1.4 vs. 6.0±0.9, p<0.01), social interactions (4.8±1.3 vs.6.3±0.7, p<0.01), emotional functioning (4.4±1.4 vs. 5.7±1.0, p<0.01), symptoms (1.6±0.8 vs. 5.8±1.2, p<0.01), and in the ESS (13.7±6.5 vs. 3.9± 3.8, p<0.01). Regarding the patients' symptoms, improvement was noticed for "sleepiness while watching a spectacle" (96%), "reading" (95%), "carrying on a conversation" (95%), "driving" (92.9%), "restless sleep" (87.8%), and "urinating more than once per night" (84.8%). Smaller improvements were observed for the reported "dry mouththroat upon awakening" (36.1%),"excessive fatigue" (54.5%), and "decreased energy" (55.3%). Conclusion We conclude that OSAS patients who adhere to nighttime CPAP therapy show significant improvement of their quality of life, daytime sleepiness, and other symptoms after 6 months of treatment with CPAP.
CPAP Adherence of Patients With Obstructive Sleep Apnea
Respiratory Care, 2013
BACKGROUND: Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up. OBJECTIVE: We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients. METHODS: Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/ BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed. RESULTS: Sixhundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Fourhundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred fortyeight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01). CONCLUSIONS: Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep. CONCLUSIONS: CPAP/ BPAP adherence should be followed with objective monitoring.
CPAP compliance in patients with obstructive sleep apnea syndrome
Sleep and Breathing, 2008
Objective: Our aim in this study is to investigate, in patients who are advised to use CPAP, the rate of usage, differences between the patients who use the device and those who don't; and the factors affecting the compliance rates. Methodology: A telephone survey was applied to the patients who underwent polysomnography, between the years 2010-2015 and were thereafter advised to use CPAP as the treatment method. Results: Total number of patients included in the study was 108. Of them, 77 (71%) was male and 31 (29%) was female. The mean age was 50 (±11). There were 47 (43,5%) patients with comorbidities. Of 108 patients, 63 (58%) reported using CPAP at the time of the survey and 45 (42%) reported having abandoned the treatment, 62% (n: 28) of this 45 patients reported that they ceased the CPAP use within the first week of their treatment. Of 63 patients using CPAP, 3 (5%) was found noncompliant while 60 (95%) was found compliant. Conclusion: In our study, rate of CPAP use was found to be 55%. The difference between the mean ages of CPAP users and non-users was found statistically significant (p: 0,008). the results of our study suggests that BMI is not a factor that affects the rate of CPAP use. In our study, contrary to what would be expected, the mean CPAP pressure of the patients using the device were found to be higher than that of non-users.