Correlates of a Prescription for Bilevel Positive Airway Pressure for Treatment of Obstructive Sleep Apnea among Veterans

Schwartz, Skai W.; Rosas, Julie; Iannacone, Michelle R.; Foulis, Philip; Anderson, William

doi:10.5664/jcsm.2580

Cited by 20 publications

(12 citation statements)

References 33 publications

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“…There is mixed evidence regarding the association between disease severity and CPAP adherence, 21,24,34,44,45 and the apneahypopnea index and CPAP pressure are collinear variables. We chose to examine CPAP pressure, as opposed to OSAHS disease severity, for several important reasons.…”

Section: Discussionmentioning

confidence: 99%

“…20,21 CPAP pressure setting and OSAHS severity have demonstrated inconsistent relationships with CPAP adherence. [21][22][23][24][25] Positive change in polysomnography (PSG)-measured sleep efficiency from diagnostic study to titration study has been shown to be predictive of better CPAP adherence, 26 so too has higher levels of educational attainment. 27 Psychological predictors of CPAP adherence have demonstrated utility, with individuals who report insomnia symptoms demonstrating poorer adherence, 25,28,29 and anxiety and depression-related symptoms also being predictive of lower levels of CPAP adherence.…”

Section: Brief Summarymentioning

confidence: 99%

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Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

Dzierzewski

Wallace

Wohlgemuth

2016

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder associated with a myriad of sequelae. OSAHS is effectively treated with continuous positive airway pressure (CPAP) therapy. However, fewer than 50% of patients are compliant with their CPAP therapy prescriptions. The current study sought to explore an integrated, biopsychological approach to CPAP adherence among experienced CPAP users. Methods: We performed a retrospective, cross-sectional analysis of a cohort of veterans with a diagnosis of OSAHS (n = 191) who were prescribed CPAP therapy and returned for adherence download at the Miami VA Sleep Clinic. The relationships between biomedical characteristics (e.g., CPAP pressure, selfreported sleepiness, and change in sleep efficiency) and psychological factors (e.g., self-efficacy beliefs and psychological diagnoses) and objectively measured CPAP use were examined to determine whether psychological factors moderated the relationships between biomedical characteristics and CPAP adherence. Results: Hierarchical regression analyses predicting CPAP adherence (adjusting for time since CPAP prescription, age, education, prescribed CPAP pressure, daytime sleepiness, changes in sleep efficiency with CPAP, and psychiatric conditions) revealed the following: (1) CPAP self-efficacy and CPAP pressure were positively related to adherence, and (2) CPAP self-efficacy moderates the relationship between CPAP pressure and CPAP adherence. Conclusions: There was no relationship between CPAP pressure and adherence in individuals with low self-efficacy beliefs. However, for individuals with high self-efficacy beliefs, there was a significant positive relationship between CPAP pressure and adherence. Self-efficacy beliefs appear to be a prime target for focused interventions aimed at improving CPAP adherence among those individuals with higher pressure prescriptions. I NTRO DUCTI O NObstructive sleep apnea-hypopnea syndrome (OSAHS) is a very common clinical condition. Population-based estimates suggest that approximately 20% of adults, or one in five, meet the criteria for at least mild OSAHS, based on an apnea-hypopnea index ≥ 5.1 OSAHS can be effectively treated with continuous positive airway pressure (CPAP) therapy.2,3 However, adherence with treatment recommendations is relatively low. 4 We sought to examine previously described biomedical and psychological factors associated with CPAP adherence, as well as investigate whether psychological factors (i.e., self-efficacy beliefs) might modify the association of biomedical characteristics and CPAP adherence.Identification of predictors of CPAP adherence is critically important given the many unwanted negative consequences of untreated OSAHS, such as deficits across multiple cognitive domains, 5,6 when viewed in context of the extremely high nonadherence rates associated with CPAP therapy. Approximately 50% of patients prescribed CPAP are completely noncompliant with therapy recommendation at 1 y. 4 In addition, 15% to 30% of patients with...

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Section: Discussionmentioning

confidence: 99%

Section: Brief Summarymentioning

confidence: 99%

Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

Dzierzewski

Wallace

Wohlgemuth

2016

Journal of Clinical Sleep Medicine

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“…A recent paper from a Veterans Administration study shows better adherence with bilevel PAP compared with CPAP, but the improvement was almost entirely seen in patients who were older, more obese, had more severe apnea or had concomitant heart failure or COPD [ 13 ].…”

Section: Bilevel Papmentioning

confidence: 99%

Positive Pressure Therapy for OSA

Feinsilver

2014

Primary Care Sleep Medicine

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“…A study by Schwartz et al . found that improved adherence to BPAP compared to CPAP was largely explained by clinical factors that would predict better suitability for BPAP.…”

mentioning

confidence: 99%

BPAP for CPAP failures: For the many or the few

Omobomi

Quan

2019

Respirology

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Correlates of a Prescription for Bilevel Positive Airway Pressure for Treatment of Obstructive Sleep Apnea among Veterans

Abstract: We identified baseline factors that can help clinicians decide whether to prescribe an auto-BPAP as first-line therapy and that predict good long-term PAP adherence.

Cited by 20 publications

References 33 publications

Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

Positive Pressure Therapy for OSA

BPAP for CPAP failures: For the many or the few

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