Strategies to augment adherence in the management of sleep‐disordered breathing

Abstract

Continuous positive airway pressure (CPAP) is highly effective in treating sleep‐disordered breathing (SDB). However, unlike surgical interventions, this treatment modality relies heavily on patient acceptance and adherence. The current definition of adherence is largely arbitrary and is mainly used by third‐party payers to determine CPAP reimbursement but CPAP adherence remains sub‐optimal. Strategies to augment adherence, especially early in the course of a CPAP trial, are needed in the management of SDB. An understanding of the basis for observed differences in CPAP and oral appliance (OA) use is necessary in developing these strategies, but to date no single factor has been consistently identified. Consequently, a multidimensional approach using educational, behavioural, technological and potentially pharmacological strategies to target (i) disease characteristics, (ii) patient characteristics including psychosocial factors, (iii) treatment protocols and (iv) technological devices and side effects that may influence adherence, is likely required to augment the complex behaviour of CPAP and OA use. In the near future, we envision a personalized medicine approach to determine the risk of non‐adherence and set individualized adherence goals aimed at treating specific symptoms (e.g. excessive daytime sleepiness) and reducing the risk of patient‐specific SDB consequences (e.g. atherosclerosis). Resources for interventions to improve adherence such as educational programmes and telemedicine encounters could then be more efficiently allocated.

ATS Core Curriculum 2020. Adult Sleep Medicine

“…Studies have explored potential modifiable and nonmodifiable predictors of PAP adherence with inconsistent results ( 3 ). Most adherent patients have higher baseline daytime somnolence, possibly worse OSA severity based on the apnea–hypopnea index (AHI), higher self-efficacy (i.e., believing the device is going to improve quality of life), and confidence for troubleshooting as well as greater social support, including bed partner engagement.…”

Contemporary Concise Review 2019: Sleep and ventilation

“…Nonetheless, the recent report highlights the need for a global strategy to address this major burden of disease. Advances in technology and care delivery are ongoing that may have an important impact on OSA management . In addition, we are strong proponents that comprehensive OSA management addresses not only continuous PAP (CPAP) therapy, but also diet, exercise and other lifestyle modifications .…”

Value and limitations of real-world data to understand paediatric adherence to positive airway pressure therapy

“…This was an observational study, so no direct causal inferences should be implied. This point of caution is particularly important for the patient engagement programme [4][5][6] and PAP pressure levels, as other factors such as patient motivation or severity of disease can confound the relationships of patient engagement and PAP pressure with adherence. Additionally, the authors noted important age-related differences in adherence, but did not specifically investigate whether risk factors for adherence differ as a function of age.…”