Early Predictors of CPAP Use for the Treatment of Obstructive Sleep Apnea

Lewis, Keir; Seale, Lisa; Bartle, Iona; Watkins, Alan; Ebden, P

doi:10.1093/sleep/27.1.134

Cited by 202 publications

(160 citation statements)

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“…Lewis et al 42 also showed that those patients who reported problems on the first night of CPAP showed worse CPAP adherence. In support of the hypothesis that better sleep on the titration night predicts better adherence, Colleen et al 43 and Lettieri et al 37 showed that use of a sedative hypnotic on the titration study night was associated with longer TST and higher sleep efficiency on that night and was also a significant predictor of higher short-term CPAP adherence.…”

Section: 3839mentioning

confidence: 99%

“…Social factors such as socioeconomic status, social support, and partner involvement have been shown in some studies to affect adherence, although not in a simple manner. 42,45,53 Similarly, psychological factors have also been shown to predict adherence in many studies, [18][19][20] although not in all. 47,49 Most of the current literature focuses on the use of psychological interventions to promote CPAP usage (CBT, 54 motivational interviewing 55 ), but these are time and resource intensive, so that identifying who would or would not benefit from these interventions may be useful.…”

Section: 49mentioning

confidence: 99%

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Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

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S C I E N T I F I C I N V E S T I G A T I O N SU ntreated obstructive sleep apnea/hypopnea syndrome (OSAHS) signifi cantly affects quality of life and cardiovascular/cerebrovascular morbidities and mortality.1-4 CPAP therapy has been shown to be effective in treating sleep disordered breathing (SDB) by reducing the apnea/hypopnea index (AHI) 5 and by reducing excessive daytime somnolence (EDS). 6Despite this, CPAP acceptance and adherence are disappointingly low. A signifi cant number of patients (ranging from 30% to 80% in various studies) demonstrate an average CPAP usage of less than 4 hours per night. 7,8 Several reviews have emphasized the need to identify patients who are at the greatest risk for non-adherence, with the goal of developing techniques to maximize overall adherence. 9,10Studies have suggested that CPAP adherence can be correlated to characteristics of patients at baseline, such as the severity of OSAHS, 11-13 the level of EDS, 14 and anatomical factors (smaller nasal cross-sectional area, reduced nasal volume, and high nasal resistance 15,16 ), but the strength of these correlations has been weak. Drake et al. showed that patients whose sleep effi ciency on the CPAP titration night improved most had the greatest CPAP compliance at 47 days.17 More recently, studies using social cognitive theory 18-20 and health BRIEF SUMMARYCurrent knowledge/Study Rationale: Despite its efficacy, adherence to CPAP therapy is highly variable amongst patients with obstructive sleep apnea with large numbers of patients demonstrating inadequate adherence to CPAP. The present study is aimed at identifying early predictors of CPAP adherence from variables obtained at the time of diagnosis and titration of CPAP, thereby providing potential for early intervention. Study Impact: Our data show that better sleep quality (greater % REM) was seen in patients with higher CPAP adherence and confi rm that long term adherence was largely predicted by short term adherence. This suggests that interventions that improve sleep during or prior to the CPAP titration study may be useful in improving CPAP adherence.

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Section: 3839mentioning

confidence: 99%

Section: 49mentioning

confidence: 99%

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

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“…5 Moreover, there are data to suggest that social support has a favorable effect on promoting CPAP adherence. [6][7][8][9][10] ans receiving CPAP therapy for OSA. Additional objective was to obtain preliminary data on the effect of PBS on CPAP adherence, vigilance, patient activation, and self-efficacy in veterans receiving CPAP therapy for OSA.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

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

Parthasarathy

Wendel

Haynes

et al. 2012

B108. Diagnostic and Therapeutic Approaches in Sleep Apnea

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BRIEF SUMMARYCurrent knowledge/Study Rationale: Poor adherence to the primary treatment of OSA-continuous positive airway pressure (CPAP) therapy-is common, and there is a paucity of easily accessible yet costeffective interventions that could promote CPAP adherence. Promoting adherence to therapy through peer-driven intervention is cost-effective and has met with modest success in other chronic conditions such as HIV, heart failure and diabetes mellitus, but whether such a peer-driven intervention can improve adherence to CPAP therapy is unknown. Study Impact: Our pilot study involved such a peer-driven intervention (experienced CPAP users called "peer-buddies") and suggests that such an intervention is feasible, results in high patient satisfaction, and promotes CPAP adherence. A larger, adequately powered study is needed, which, if successful, could potentially improve outcomes in a "patientcentered" and cost-effective manner.

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“…6,7 Prior studies suggest that medical and psychiatric conditions may influence CPAP adherence. [8][9][10][11] Additionally, intensive follow-up has been suggested to improve adherence to CPAP. 12 It is, however, unclear whether the expectation of an adherence evaluation alters patients' behavior regarding CPAP use.…”

Section: Introductionmentioning

confidence: 99%

“…9,10,24 Other studies, 8,25 however, have shown a significant association between presence of depression or claustrophobia and diminished CPAP adherence. However, we did find a trend toward reduced CPAP adherence in the presence of anxiety.…”

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confidence: 99%

Impact of Randomization, Clinic Visits, and Medical and Psychiatric Cormorbidities on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea

Budhiraja

Kushida

Nichols

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives:To evaluate factors associated with continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES) cohort. Methods: The data from a prospective 6-mo multicenter randomized controlled trial with 558 subjects randomized to active CPAP and 547 to sham CPAP were analyzed to assess adherence to CPAP during first 2 mo (early period) and during months 5-6 (late period). Results: Participants randomized to active CPAP had higher hours of nightly adherence compared to the sham CPAP group at both 2 (4.9 ± 2.0 h versus 4.07 ± 2.14 h, p < 0.001) and 6 mo (4.70 ± 2.08 h versus 3.41 ± 2.19 h, p < 0.001). Those assigned to sham CPAP were more likely to correctly identify their treatment group (70.0% versus 55.2%, p < 0.001). Irrespective of treatment group assignment, those who believed they were receiving active CPAP had higher hours of adherence than those who thought they were in the sham CPAP group at both 2 mo (4.91 ± 2.01 versus 4.17 ± 2.17, p < 0.001) and 6 mo (4.65 ± 2.10 versus 3.65 ± 2.22, p < 0.001). Among those randomized to active CPAP, older age was significantly related to CPAP use > 4 h per night. Presence of cardiovascular disorders was associated with higher hours of CPAP use, whereas presence of anxiety was associated with a trend toward lower hours of CPAP use. Presence of nasal congestion was associated with a decrease in mean daily CPAP use between the early and the late adherence period. The adherence during the week prior to a clinic visit was higher than the average adherence during the 2-mo period prior to the visit. Conclusions: Randomization to active therapy, belief that one is in the active treatment group, older age, and possibly presence of cardiovascular disorders are positively linked to CPAP adherence. Nasal congestion and anxiety are negatively associated with CPAP adherence. CPAP nightly usage increases as clinic visits approach. Keywords: adherence, age, comorbid, compliance, continuous positive airway pressure, CPAP, medical disorders, obstructive sleep apnea, psychiatric disorders, race, sex, sleep disordered breathing Citation: Budhiraja R, Kushida CA, Nichols DA, Walsh JK, Simon RD, Gottlieb DJ, Quan SF. Impact of randomization, clinic visits, and medical and psychiatric cormorbidities on continuous positive airway pressure adherence in obstructive sleep apnea. J Clin Sleep Med 2016;12(3):333-341. I NTRO DUCTI O NObstructive sleep apnea (OSA) is a common disorder, 1 and continuous positive airway pressure (CPAP) therapy continues to be the first-line treatment for the majority of patients with OSA. This therapy is associated with multiple salutary effects including improvement in daytime sleepiness, reduction in blood pressure 2 and improvement in diabetic control. However, poor adherence to CPAP continues to be a major impediment to effective therapy of this disorder. Long-term adherence to CPAP of greater than 4 h per night is achieved by only 50% to 70% of patients....

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Early Predictors of CPAP Use for the Treatment of Obstructive Sleep Apnea

Cited by 202 publications

References 31 publications

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Sleep Quality, Short-Term and Long-Term CPAP Adherence

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

Impact of Randomization, Clinic Visits, and Medical and Psychiatric Cormorbidities on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea

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