A psychological view on the effectiveness of psychosocial interventions on positive airway pressure treatment adherence and sleep quality in patients with obstructive sleep apnea

Abstract

Positive airway pressure treatment (CPAP) is the gold standard for obstructive sleep apnea syndrome (OSAS). CPAP is highly effective, but its issue lays in poor adherence rates mainly caused by its invasive nature and related stigma. In accordance with a biopsychosocial model of CPAP adherence, psychosocial interventions have been implemented to alleviate low rates of adherence with promising results. The increase in the number of psychosocial interventions has highlighted the need to systematically evaluate their effectiveness. This review aims to identify psychosocial interventions used to increase CPAP adherence, to compile available data on their effectiveness, and the reasons why they are effective. Moreover, the review evaluates the impact of the interventions on sleep quality. Experimental and quasi-experimental studies testing psychosocial interventions (excluding educational only interventions) that aimed to increase CPAP adherence in adults with obstructive sleep apnea vs. no intervention or control group were included. A literature search in PsycINFO, MEDLINE, COCHRANE, EMBASE, CINAHL, and Web of Science was performed for studies published in English and French between 1980 and January 2020. Risk of bias and methodological quality were assessed using the Joanna Briggs Institute Critical Appraisal Tools. Fourteen studies were included involving 1923 participants, six trials tested a motivational intervention, three trials tested a cognitive behavioral intervention and five others tested one of the following: relaxation, exposition therapy, phone coaching, audiotape or stage-matched intervention. Thirteen studies reported a positive effect of the intervention on CPAP adherence, while one reported no effect. Psychosocial interventions for CPAP adherence appear effective at increasing sleep quality, but more studies are needed to test this hypothesis. Reasons for the effectiveness of the interventions were pooled into five categories: time related, the intervention's adaptability, the patient's characteristics, the intervention's nature and characteristics and the intervention's specifics and target. The current review raises a significant gap between the biomedical and psychosocial domains. In fact, even in a psychosocial intervention study, the interpretation of the results revolves around biomedical models and very little consideration is given to biopsychosocial models. Our findings demonstrate the importance of examining the relationship between psychosocial variables and CPAP adherence to better tailor interventions to increase CPAP adherence.