Factors affecting the compliance with ventilatory assistance using positive pressure to treat sleep apnea for spinal cord-injured patients: Results of qualitative study

Abstract

Sleep apnea is a frequent issue for the general population, with a prevalence between 2 and 4%. It is 2 to 5 times more frequent for the spinal cord-injured population. The night ventilation by positive pressure is the reference treatment but the compliance is still an issue. Its determinants are well studied in the general population, but we have limited data for the spinal cord-injured patients. The goal of this study is to elaborate a comprehensive model of compliance with ventilatory assistance using positive pressure for spinal cord-injured patients affected by sleep apnea. Qualitative, prospective, monocentric study based on semi-directed interview, which are based on Bandura social cognitive theory. Each interview is recorded and transcribed. Data are analysed by the working group according to the grounded theory: codification, categorisation and liking. We included 15 patients which allows to generate 90 codes. This code's categorisation is in process and highlights the fact that spinal cord-injured patients face the same compliance determinants than the general population (factors related to material, provider, medical team, patient belief) but also factors specific to the handicap situation of the spinal cord-injured patient in term of constraints, autonomy and priority of care. The model of compliance generated by this study will lead the practitioner in setting up the ventilatory assistance and its integration in the day-to-day functioning for a spinal cord-injured person.