Usefulness of reinforcing interventions on continuous positive airway pressure compliance

Abstract

BackgroundObstructive sleep apnea (OSA) is a high prevalence sleep disorder characterized by upper airway obstruction during sleep, nocturnal intermittent hypoxemia, poor sleep quality, risk for cardiovascular and metabolic diseases. The adherence to CPAP is the key for an effective management of these patients.The aim of the study was to assess the adherence to CPAP therapy with and without early reinforcing interventions, consisting of motivational reinforcement and technical support in the first month of therapy.MethodsForty patients with OSA undergoing counseling and a one year follow-up on a quarterly basis were included in the study. Twenty subjects (intervention group) underwent reinforcing interventions with telephone interviews in the first month of therapy, and twenty (control group) remained without reinforcing interventions. The two populations were homogeneous for age, severity of illness and BMI.ResultsDuring the first month, intervention group patients showed a higher number of nights with a device use ≥4 hours. Average treatment adherence in the first month (days of therapy with at least 4 hours per night on the total number of days from device delivery) was 77.5% in the intervention group and 55.7% in the control group (p = 0.022). At one year the differences between the two groups were not significant.ConclusionsOur findings suggest that it is important that adequate time and effort is spent to ensure patient comfort at the time of CPAP therapy start to optimize acceptance and adherence to treatment, and suggest that it is necessary to maintain reinforcing interventions over time.

Effectiveness of Electronic Health Interventions in Improving Treatment Adherence for Adults With Obstructive Sleep Apnea: Meta-Analytic Review

“…All studies, except one [34], included postintervention assessments between 1 and 4 months after baseline. Five studies included follow-up assessments after completion of the intervention [26,30,33,35,36], ranging from 1 month [30] to 2 years [26].…”

An Update on Behavioural Interventions for Improving Adherence with Continuous Positive Airway Pressure in Adults

“…In contrast to work by Lo Bue [69] and Sedkaoui [73], this study incorporated a multidisciplinary team approach where not only CPAP nurses and sleep physicians were involved in the delivery of both telephone and face-to-face support but patients' partners and/or family members were required to attend all follow-up care activities, again highlighting the importance of family support and involvement [28,84]. Another nurse-led intensive intervention resulted in higher CPAP use compared to a standard care programme at 1-year follow-up [72], and similar to Bouloukaki [70], this intervention involved both telephone and face-to-face support.…”

“…Lo Bue and colleagues [69] found early telephone support by a sleep physician during the first week of CPAP therapy and at 1 month resulted in better adherence during the first month of therapy compared with standard care. However, these beneficial effects of early support were not maintained past the 1-month time frame.…”

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

“…These ‘total rejectors’ have never been the focus of detailed research. If side effects can be overcome, behavioural strategies to increase adherence such as reinforcement can be used but ultimately, many patients will require a switch to an alternative therapy.…”