Interventions to improve adherence to PAP in patients with obstructive sleep apnea: does the patient’s personality matter?

Abstract

Our previous research suggests that some obstructive sleep apnea patients respond best to educational interventions whereas others respond best to motivational enhancement therapy to improve their adherence to positive airway pressure (PAP) therapy.The objective of this study was to explore whether patients’ personality profiles could predict their responses to distinctive interventions to optimize PAP adherence. A total of 275 PAP-naive patients with newly diagnosed OSA (mean age = 52.6 years, SD = 11.3; 60.4% men) were randomly allocated to three treatment conditions: Motivational Enhancement Therapy, MET ( n = 89), Education, ED ( n = 83) or Standard Care, SC ( n = 103).Prior to PAP treatment, patients completed a battery of questionnaires.For the purpose of this study we selected patients’ scores on the Self-efficacy scale and on the six subscales of the Conscientiousness Scale of the NEO-Personality inventory.These data were first analyzed analyzed using profile analysis via multidimensional scaling (PAMS) to derive prototypic core profiles for the sample.We then related the person parameters derived by PAMS (each individual’s weights on the profiles and the profile level parameter) to adherence outcomes, such as (1) number of nights the PAP was used, regardless of its duration of use (all use) (2) number of nights the PAP was used for more than 4 h (optimal use).Both adherence measures were computed at week 1, and at month 3, after the interventions were completed. We retained a 2-dimensional solution because of its fit and interpretability (Stress = .13, RSQ = .95), with 2 prototypical profiles associated to each dimension.In a multivariate multiple regression analysis including the person parameters and controlling for the apnea severity index, we found that patients’ loadings on the profile marked by high self-efficacy was positively associated with adherence to PAP during the first week of treatment (all use, p = .007, and optimal use, p = .01). Likewise loadings on the profile defined by high self-efficacy remained a positive predictor of PAP adherence at 3 months, even when adding to the factor Treatment to the statistical model (all use, p = .005 and optimal use, p = .01).However, there was an interaction between Treatment and weights on dimension 2’s profiles, p = .01.Post-hoc analyses revealed that, among individuals in the ED group, higher weights on the profile characterized by high scores on the Competence and Dutifulness scale were associated to higher number of nights the PAP was used ( p = .02).By contrast, among individuals receiving the MET, higher weights on the profile marked by high scores on the Order and Deliberation subscales, was associated to greater PAP use( p = .04). Whereas individuals with higher self-efficacy may not need additional educational or motivational interventions to bolster their PAP adherence, MET and ED may have different impact for patients with distinctive personality profiles. This data suggest that assessing the patients’ self-efficacy and personality profiles prior to PAP treatment may be a helpful strategy to optimize patient allocation to interventions to improve their adherence. Research funded by the National Institute of Health, US . MMSO was a recipient of a Fundación Séneca’s award.