Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis (original) (raw)
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Behavioral Sleep Medicine, 2014
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.
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.
Factors that influence CPAP adherence: an overview
Sleep and Breathing, 2010
Background Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea syndrome (OSAS). Consistent adherence to CPAP improves the patient’s longevity and quality of life as well as public safety. However, nonadherence is a significant contributor to the growing burden of untreated OSAS, and is associated with negative consequences for the patient, public safety, and the healthcare system. Objective The use of CPAP is a classic example of an effective treatment for which adherence is extremely variable. This paper examines a multiplicity of factors that influence CPAP adherence. Factors These factors are traditionally thought of in terms of patient and equipment variables, but in addition physician, family, healthcare facility, and governmental issues all contribute to CPAP adherence. Discussion These factors are reviewed and pragmatic recommendations are made for improving clinical practice.
Balneo Research Journal, 2020
Obstructive sleep apnea (OSA) has become a major worldwide health concern and affects 2-4% of males and 1-2% females. In subjects diagnosed with mild or severe OSA, CPAP (Continuous Positive Airway Pressure) is highly efficacious in improving the specific quality of life and the cardiovascular outcome but adherence to treatment limits its overall effectiveness. Factors that influence the adherence to CPAP therapy include patients' individual characteristics, disease severity, titration procedures, the presents of side effects and the psychosocial factors. The management of this pathology is multidimensional and is based on some interventions such as lifestyle modifications, physical training, oral appliance and educational, pharmacological, technological strategies. These measures are implemented to limit the adverse effects of CPAP therapy in order to maximize the CPAP usage and to obtain a decrease of symptomatology and an optimum quality of life in OSA patients.
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.
Frontiers in Psychology, 2021
Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of motivational interventions to increase adherence to Continuous Positive Airway Pressure (CPAP) among patients with Obstructive Sleep Apnea Syndrome (OSAS) and of their specific aspects and strategies by assessing adherence measures.Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the concepts of “obstructive sleep apnea syndrome,” “continuous positive airway pressure,” “motivational intervention,” and “adherence.” Rigorous inclusion criteria and screening by at least two reviewers were applied. Data were extracted to address the review aims and were presented as a narrative synthesis.Results: Search for databases produced 11 randomized controlled trials, all including naïve CPAP users. Findings showed that motivational interventions were more effective than usual care and educational programs in increasing ad...
2021
Purpose The aim was to determine adherence to CPAP and health-related outcomes in patients with OSA via a comprehensive program based on stratification and individualized care plans, including motivational interview. Methods A multicentre, randomized controlled trial (RCT) design was used in 3 hospitals. The control group followed the usual treatment. Intervention group (PIMA) followed the treatment with an adapted care plan (home visits, telephone, care-center) depending on socio-demographic, clinical and psychological variables, using motivational interviews in all the interventions. The main outcome was adherence, and secondary were quality of life, emotional state, activities, social relationships, perceived competence, and motivation. The clinical trial was registered with www.clinicaltrials.gov (NCT 04691479). Results 213 patients (68.1% men, 58.7% between 51–69 years old, 45.5% upper-secondary school education) were randomized: 108 were in the intervention group and 105 were ...
Sleep Science, 2009
Obstructive Sleep Apnea Syndrome (OSAS) is characterized by partial (hypopnea) or total (apnea) airway obstruction during sleep. These respiratory events usually cause hypoxemia and sleep fragmentation (1). Patients with OSAS complain of hypersomnolence and loud snoring, and their bed partners report witnessing sleep apneas (2). Continuous Positive Airway Pressure (CPAP) is considered the standard of care for treating moderate to severe OSAS (3). CPAP has been reported to abolish obstructive respiratory events, correct nocturnal oxyhemoglobin desaturation (4,5), and improve self-reported sleepiness (3,6). CPAP therapy could decrease blood pressure in OSA hypertensive patients (3,5,7,8). In addition, some studies suggested that CPAP may improve quality of life (3,9,10), mood, and cognitive function (3,11,12). CPAP therapy is safe, and the most common side effects are related to the nasal mask itself, such as air leaks or ulceration of the bridge of the nose (13). Nasal congestion, rh...