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Abstract
Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea. However, the success of this treatment is hampered by nonadherence in half of the treated patients. Moreover, in clinical trials, poor adherence reduces adequate exposure required to determine its true effect. There is growing evidence that behavioral interventions, in addition to education, are a promising approach to improving adherence. Behavioral interventions include the use of cognitive behavioral therapy and motivational enhancement therapy designed to elevate a patient’s self-efficacy. The abundance of data obtained by CPAP tracking systems enables daily surveillance of use, and this telemonitoring along with telehealth allows the provider to quickly intervene when nightly CPAP use falls below thresholds or mask leaks are present. Telehealth reaches a large number of patients who may not be able to regularly attend a clinic, providing support and reinforcement. Peer support may also be useful in improving adherence. Not all obstructive sleep apnea patients present with the same phenotype, and can, therefore, be clustered into several groupings. Which intervention is most successful with a given phenotype or cluster remains unexplored. Comprehensive adherence management requires a team approach with the unique contribution of different professionals.
Highlights
Continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) improves daily functioning, cognitive processing, and mood, while positively affecting insulin resistance and possibly reducing the risk of stroke, hypertension, and cardiovascular disease [1]
Even skipping one night of treatment returns the number of apnea and hypopnea events, subjective and objective daytime sleepiness, and cognitive processing to baseline levels [5]
Does this limited treatment exposure affect clinical outcomes, it limits the evaluation of the impact of CPAP on such comorbidities as cardiovascular disease, diabetes, hypertension, and cancer in clinical trials, underestimating the effect size
Summary
Continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) improves daily functioning, cognitive processing, and mood, while positively affecting insulin resistance and possibly reducing the risk of stroke, hypertension, and cardiovascular disease [1]. The use of CPAP has decreased traffic and other work-related accidents in addition to enhancing work productivity [1] Despite these very significant effects that influence quality of life, adherence to this treatment remains a formidable obstacle to its effectiveness. Even skipping one night of treatment returns the number of apnea and hypopnea events, subjective and objective daytime sleepiness, and cognitive processing to baseline levels [5] Does this limited treatment exposure affect clinical outcomes, it limits the evaluation of the impact of CPAP on such comorbidities as cardiovascular disease, diabetes, hypertension, and cancer in clinical trials, underestimating the effect size. Models of care to more efficiently implement such interventions in the clinical setting will be discussed
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