Improving Compliance with Nasal CPAP and Vigilance in Older Adults with OSAHS

Abstract

The present study examined the efficacy of a cognitive-behavioral intervention at improving compliance with CPAP and vigilance in older adults with obstructive sleep apnea/hypopnea syndrome (OSAHS). Participants included 12 subjects who were randomized into one of two groups controlling for age, education, disease severity, and vigilance. The experimental group received two 45-min sessions designed to educate subjects on the consequences of OSAHS and the efficacy of CPAP. The control group received the same extent of therapist contact but did not receive information on OSAHS or CPAP. All subjects were administered a test of vigilance both before and after the study. Compliance data were collected using CPAP devices with internal microprocessors at were read at 1, 4, and 12 weeks after treatment initiation. The results showed that the experimental condition did not enhance compliance after 1 week of treatment but did so by the 12-week follow-up. Subjects in the experimental condition had a run time of 3.2-h per night longer than did those in the control group. Those using CPAP more regularly at 12 weeks also showed greater improvement on vigilance at follow-up. Performance on vigilance testing before the introduction of CPAP was predictive of CPAP use at 12 weeks. In conclusion, a modest cognitive-behavioral intervention may substantially increase CPAP use and vigilance in older adults.

A systematic review of CPAP adherence across age groups: Clinical and empiric insights for developing CPAP adherence interventions

“…(71–73) The earliest study to examine a CBT intervention was a pilot randomized placebo-controlled trial in older adults (age 63.4 ± 4.5 years) with severe OSA, naïve to CPAP. (73) The intervention group received 2–45 minute sessions, one-on-one, that provided participant-specific information about OSA, symptoms, cognitive testing performance, treatment relevance, goal development, changes in symptoms with CPAP, troubleshooting advice, treatment expectations, and treatment goal refinement. There were no differences in short-term CPAP use (i.e., 1 and 4 weeks).…”

Spousal involvement and CPAP adherence: A dyadic perspective

“…The positive effects may be difficult to sustain when intensive support stops. Motivational enhancement therapy 66–68 and cognitive behavioral therapy 69 are promising interventions based on either self-management of disease or motivational enhancement, and have been reported to improve CPAP adherence. Self-efficacy and social support are important elements in these successful interventions.…”

“…99 In a recent review of interpersonal factors in insomnia, Rogojanski and colleagues 100 presented a model for integrating bed partners into cognitive behavioral therapy to further enhance its efficacy. This model offers great insight into how to integrate spouses into behavioral interventions such as cognitive behavioral therapy 69 and motivational enhancement therapy 66, 67 to improve their effectiveness at increasing CPAP adherence.…”

Immediate and Long-term Neurocognitive Outcome in Patients with Obstructive Sleep Apnea Syndrome After Continuous Positive Airway Pressure Treatment

“…Weaver et al showed a dose response on day time function on CPAP duration after 3 months of treatment by MSLT and questionnaire [35]. Aloie et al showed baseline neuropsychologic function have influence on the compliant rate and additional improvements in psychomotor speed and nonverbal learning was noted in compliant patients [36,37]. Active intervention could improve the compliance rate in their study.…”