Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea

Smith, Ian; Nadig, Vidya; Lasserson, Toby J

doi:10.1002/14651858.cd007736

Cited by 95 publications

(62 citation statements)

References 41 publications

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“…Many psychological and educational interventions have been proposed as a means of increasing the hours of use of CPAP therapy. These interventions include education about the risks of OSAHS, outcome expectancies for CPAP treatment and CPAP self-efficacy; supportive measures, such as strategically timed follow-up appointments and telephone calls; and reinforcement of the patients' perception of the improvement in symptoms following CPAP therapy [7,8,12,14,16,[30][31][32][33][34][35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

et al. 2014

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We aimed to compare the effect of intensive versus standard interventions on continuous positive airway pressure (CPAP) adherence 2 years after CPAP initiation, as well as on sleepiness, quality of life, depression, hospitalisation and death rate due to cardiovascular disease (CVD). 3100 patients with newly diagnosed sleep apnoea were randomised into the standard group, with usual follow-up care, or the intensive group, with additional visits, telephone calls and education. Subjective daytime sleepiness (Epworth Sleepiness Scale; ESS), quality of life (36-item Short Form Health Survey; SF-36) and the patient's level of depression (Beck Depression Inventory; BDI) were recorded before and 2 years after CPAP initiation, together with CVD hospitalisations and death rate.2 years after CPAP initiation, the intensive group used CPAP significantly more than the standard group (6.9 versus 5.2 h per night; p,0.001). ESS, SF-36 and BDI scores were also significantly better in the intensive group. Furthermore, the standard group had significantly more deaths and hospitalisations due to CVD.CPAP usage can be improved by both intensive and standard patient support. However, the patients who received intensive CPAP support had significantly better ESS, BDI and SF-36 scores, and lower cardiovascular morbidity and mortality, suggesting that an intensive programme could be worthwhile. @ERSpublications Intensive CPAP support improves sleepiness, quality of life, depression, hospitalisation and death rate

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Section: Discussionmentioning

confidence: 99%

Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

et al. 2014

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“…[1][2][3] The need for a reliable source of electricity and inconvenience with travel further limit its use. Mandibular advancement devices, or oral appliances (OAs), are an approved, frequently effective alternative to CPAP for the treatment of OSA.…”

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confidence: 99%

Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

Lettieri

Paolino

Eliasson

et al. 2011

Journal of Clinical Sleep Medicine

118

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Study Objectives: To compare the effi cacy of adjustable and fi xed oral appliances for the treatment of OSA. Methods: Retrospective review of consecutive patients with OSA treated with either adjustable or fi xed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defi ned as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared effi cacy rates between fi xed and adjustable appliances and sought to identify factors associated with greater success. Results: We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fi xed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was signifi cantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fi xed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fi xed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. Conclusions: Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these fi ndings, the baseline AHI should be considered when selecting the type of oral appliance. Keywords: Oral appliance, mandibular advancement device, obstructive sleep apnea, effi cacy Citation: Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fi xed oral appliances for the treatment of obstructive sleep apnea.

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“…The effectiveness of these and other interventions are widely debated throughout the recent sleep literature. [21][22][23][24][25] Most of the newer PAP devices incorporate sophisticated compliance and efficacyreporting software, with detailed reports routinely available at the time of office visits as well as via real-time wireless transmission. Some practitioners have developed and implemented comprehensive compliance-enhancement programs with encouraging results.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea Syndrome with Nasal Positive Airway Pressure Improves Golf Performance

Benton

Friedman

2013

Journal of Clinical Sleep Medicine

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Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea

Cited by 95 publications

References 41 publications

Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

Treatment of Obstructive Sleep Apnea Syndrome with Nasal Positive Airway Pressure Improves Golf Performance

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