A Pilot Study Of CPAP Adherence Promotion By Peer Buddies With Sleep Apnea

471

306

Introduction:The purpose of this systematic review is to provide supporting evidence for the clinical practice guideline for the treatment of obstructive sleep apnea (OSA) in adults using positive airway pressure (PAP). Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of PAP with no treatment as well as studies that compared different PAP modalities. Meta-analyses were performed to determine the clinical significance of using PAP in several modalities (ie, continuous PAP, auto-adjusting PAP, and bilevel PAP), to treat OSA in adults. In addition, meta-analyses were performed to determine the clinical significance of using an in-laboratory versus ambulatory strategy for the initiation of PAP, educational and behavioral interventions, telemonitoring, humidification, different mask interfaces, and flexible or modified pressure profile PAP in conjunction with PAP to treat OSA in adults. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. Results: The literature search resulted in 336 studies that met inclusion criteria; 184 studies provided data suitable for meta-analyses. The data demonstrated that PAP compared to no treatment results in a clinically significant reduction in disease severity, sleepiness, blood pressure, and motor vehicle accidents, and improvement in sleep-related quality of life in adults with OSA. In addition, the initiation of PAP in the home demonstrated equivalent effects on patient outcomes when compared to an in-laboratory titration approach. The data also demonstrated that the use of auto-adjusting or bilevel PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP. Furthermore, data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions. Systematic reviews for specific PAP delivery method were also performed and suggested that nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity, heated humidification compared to no humidification reduces some continuous PAP-related side effects, and pressure profile PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.

Section: Adherence (Behavioral Interventions)mentioning

confidence: 95%

Section: Educational Behavioral and Troubleshooting Interventions With Pap Versus Pap Alonementioning

confidence: 99%

Section: Adherence (Behavioral Interventions)mentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment

Patil

Ayappa

Caples

et al. 2019

471

306

“…It is not clear if the study monitors employed any type of individual encouragement or help other than providing "the best mask fit" to improve CPAP usage even though there are methods that can improve adherence. 8,9,10 It is abundantly clear that more hours with CPAP results in improved measures such as lower blood pressure, reduced sleepiness and increased quality of life. 11,12 One would assume that such improvements would similarly translate to fewer cardiovascular events.…”

Section: Co M M Entarymentioning

confidence: 99%

SAVE Me From CPAP

Collop

Stierer

Shafazand

2016

In individuals with moderate to severe obstructive sleep apnea (OSA) and cardiovascular disease, does the treatment of OSA with continuous positive airway pressure therapy (CPAP), in addition to medical management of cardiovascular disease (usual care), reduce the incidence of the primary composite end point (death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack)? Methods DesignMulti-center, randomized, parallel-group, open-label trial, with blinded end-point assessment; ClinicalTrials.gov identifier: NCT00738179; Australian New Zealand Clinical Trials Registry number: ACTRN12608000409370. AllocationRandomization was conducted by a centralized computer system. The randomization sequence was concealed. Randomization was performed with the use of a minimization procedure and stratification was according to study site, type of cardiovascular disease (cardiac, cerebrovascular, or both), and severity of daytime sleepiness (Epworth Sleepiness Scale score < 11 vs. ≥ 11). BlindingThe investigators and participants were not blinded to study arm assignment. The primary and secondary outcome measurements were blinded. Follow-up periodThe end of the study was when a statistically pre-determined number of efficacy endpoint events had been observed or every patient had participated for at least 1.5 years. The mean followup was 3.7 years. JOURNAL CLUB SAVE Me From CPAPSummary and commentary on McEvoy et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea.

“…32 There is also evidence that peer coaching could help improve PAP adherence. 33 Our study, also known as the Improving CPAP Adherence Program (I-CAP) study, aimed to provide a multidimensional treatment framework based on shared decision-making, patient activation, and caregiver engagement. We hypothesized that our I-CAP study would promote and support active patient participation, and that it would engage the caregiver to enhance long-term PAP acceptance and adherence.…”

Section: Introductionmentioning

confidence: 99%

Semistructured Motivational Interviews of Patients and Caregivers to Improve CPAP Adherence: A Qualitative Analysis

Khan

Olomu

Bottu

et al. 2019

The aim of this qualitative analysis was to identify obstructive sleep apnea (OSA) patients' preferences, partner experiences, barriers and facilitators to positive airway pressure (PAP) adherence, and to assess understanding of the educational content delivered and satisfaction with the multidimensionally structured intervention. Methods: A qualitative analysis was conducted on 28 interventional arm patients with a new diagnosis of OSA. They received a one-on-two semistructured motivational interview as the last part of a 60-to 90-minute in-person educational group intervention. The 10-to 15-minute interview with the patient and caregiver was patient-centered and focused on obtaining the personal and emotional history and providing support. We also assessed understanding of the OSA training plan, their commitment to it, and their goals for it. Results: We identified four themes: OSA symptom and diagnosis, using the PAP machine, perceptions about the group visit, and factors that determine adherence to PAP. Patients experienced positive, negative, or mixed emotions during the journey from symptoms of OSA to PAP adherence. Conclusions: Our findings suggest that patients' and caregivers' positive experiences of PAP could be enhanced by a patient-centered interaction and that it was important to explicitly address their fears and concerns to further enhance use of PAP. Not only could caregiver support play a role in improving PAP adherence but also the peer coaching session has the potential of providing a socially supportive environment in motivating adherence to PAP treatment.