Self-Efficacy in Sleep Apnea: Instrument Development and Patient Perceptions of Obstructive Sleep Apnea Risk, Treatment Benefit, and Volition to Use Continuous Positive Airway Pressure

Weaver, Terri E.; Maislin, Greg; Dinges, David F.; Younger, Joel; Cantor, Charles R.; McCloskey, Susan A.; Pack, Allan I.

doi:10.1093/sleep/26.6.727

Cited by 174 publications

(146 citation statements)

References 51 publications

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“…12,13,30 Such educational interventions directed at patients may have played a role in previous findings of better PAP adherence in OSA patients managed by specialists. 7,8 Specifically, in patients with OSA being treated by PAP therapy, Weaver and colleagues demonstrated that three major cognitive factors play a role in adherence to PAP therapy-the patient's perception of health risk associated with OSA, the patient's expectations of outcomes, and the patient's perceived ability to use the PAP device.…”

Section: Patient Educationmentioning

confidence: 96%

“…7,8 Specifically, in patients with OSA being treated by PAP therapy, Weaver and colleagues demonstrated that three major cognitive factors play a role in adherence to PAP therapy-the patient's perception of health risk associated with OSA, the patient's expectations of outcomes, and the patient's perceived ability to use the PAP device. 13 All three of these factors can be favorably influenced by interventions that can deliver adequate patient education. 31,32 In our previous study, patient education leading to better patient perception of risk due to OSA was associated with better PAP adherence.…”

Section: Patient Educationmentioning

confidence: 99%

“…10 Specifically, patient education regarding their chronic disease condition can help improve risk perception and self-efficacy, and consequently serve to promote adherence to therapy and further improve health and well-being. [10][11][12][13] In our previous national survey, we demonstrated that patient education and risk perception mediated the observed better PAP adherence in patients cared for by accredited centers and certified physicians, but such cross-sectional measurements may be subject to recall bias and needed to be performed in a prospective manner. 7 Other important benchmarks in the management of patients with OSA such as timely delivery of care and patient satisfaction with care rendered by their physicians and centers are important patient-centric quality metrics that needed to be assessed.…”

mentioning

confidence: 99%

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A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

Parthasarathy

Subramanian²,

Quan

2014

Journal of Clinical Sleep Medicine

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than those who did not receive such sleep specialist consultation. 8 Recently, a randomized controlled non-inferiority trial reported that treatment of OSA by primary care physicians was non-inferior to that of sleep specialists with regard to resolution Objectives: To study the effect of sleep center accreditation and Sleep Medicine board certifi cation of physicians on patient-centered outcomes in obstructive sleep apnea (OSA). Design: Prospective, multicenter, comparative effectiveness study. Setting: Four sleep centers Patients: 502 patients with OSA. Interventions: None. Measurements and Results: Patients at two accredited and two non-accredited centers underwent polysomnography at participating locations and completed validated questionnaires, with objective measurement of positive airway pressure (PAP) therapy adherence performed three months after therapy initiation. The proportion of patients (age 53 ± 13[SD] years; 26% women; and body mass index 33.6 ± 7.2 kg/m 2 ) who were adherent to PAP therapy by Medicare guidelines (> 70% of nights with ≥ 4 h use over a 30-day period) was greater in accredited (79%) than non-accredited sites (64%; p = 0.004). After adjustment for confounding variables, patients who received care from accredited centers (odds ratio [OR] 2.2, 95% confi dence interval [CI], 1.2-4.2; p = 0.016) and certifi ed physicians (OR 2.3, 95% CI, 1.3-4.0; p = 0.005) were more likely to be adherent to PAP therapy than those who received care from non-accredited centers and non-certifi ed physicians. Patient satisfaction was associated with greater education received from physician (OR 4.6; 95% CI 2.3-9.3); greater risk perception (OR 2.7; 95% CI 1.0-7.4); physician certifi cation (OR 2.1; 95% CI 1.1-4.2); and inversely related to delays in care (OR 0.5; 95% CI 0.3-0.9; p < 0.05). Such delays were inversely related to accreditation-certifi cation status (p < 0.0001). Conclusions:In patients with OSA, accreditation-certifi cation status of sleep centers and physicians was associated with better PAP adherence, better patient education, better patient satisfaction, and greater timeliness. S C I E N T I F I C I N V E S T I G A T I O N SH ealth care delivery in many disease conditions including obstructive sleep apnea (OSA) will be increasingly driven by quality metrics.1-3 One of the important quality metrics for OSA-adherence to positive airway pressure (PAP) therapyremains a huge problem, with adherence of greater than four hours of daily use ranging from 46% to 83%. 4,5 There is much emphasis on patient-centered care that focuses on outcomes relevant to patients such as improving patient satisfaction and enhancing the patient experience. 6 We have previously shown that in a cross-sectional national survey, patients with OSA cared for by American Academy of Sleep Medicine (AASM) accredited sleep centers or Sleep Medicine board-certifi ed physicians had lower positive airway pressure (PAP) discontinuation rates and reported greater patient satisfaction than patients cared for by non-accredited cent...

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Section: Patient Educationmentioning

confidence: 96%

Section: Patient Educationmentioning

confidence: 99%

mentioning

confidence: 99%

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A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

Parthasarathy

Subramanian²,

Quan

2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

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“…At the time of unattended polysomnography, patients received the standardized educational session (previously described). At the time of CPAP delivery, patients completed a questionnaire about attitudes and beliefs about sleep apnea, social supports, and individual risks for consequences of sleep apnea and the Self‐Efficacy Measure in Sleep Apnea 12. The staff was trained to identify patient‐specific barriers and facilitators of CPAP adherence.…”

Section: Methodsmentioning

confidence: 99%

Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

Bravata

Sico

Fragoso

et al. 2018

JAHA

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BackgroundObstructive sleep apnea (OSA) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes.Methods and ResultsThis randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of OSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention‐to‐treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as‐treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, −0.6±2.9; some, −0.9±1.4; good, −0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, −0.3±1.5; some, −0.4±1.0; good, −0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0–1) versus 38% of controls (P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8).ConclusionsAlthough changes in neurological functioning and functional status were similar across the groups in the intention‐to‐treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01446913.

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“…18 (e) Nasal congestion score (confounder): a validated questionnaire that assesses nasal congestion using a 5-point Likert scale that was previously administered to patients with sleep disordered breathing 19 and found to be associated with discontinuation of CPAP therapy. 15 This questionnaire was used to screen out patients who may be non-adherent due to excessive nasal congestion.…”

Section: Measurementsmentioning

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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Self-Efficacy in Sleep Apnea: Instrument Development and Patient Perceptions of Obstructive Sleep Apnea Risk, Treatment Benefit, and Volition to Use Continuous Positive Airway Pressure

Abstract: These findings indicate that the SEMSA has strong psychometric properties and has the potential for identifying patient perceptions that may indicate those most likely to not adhere to treatment.

Cited by 174 publications

References 51 publications

A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease

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

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