Stage-matched intervention for adherence to CPAP in patients with obstructive sleep apnea: a randomized controlled trial

Abstract

The objective of the study was to evaluate the effectiveness of stage-matched intervention on adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome. One hundred and ten Chinese patients with newly diagnosed obstructive sleep apnea syndrome were enrolled in this study. They were randomly assigned into stage-matched care (SMC) and standard care (SC) groups (55 patients in each group). Patients in the SMC group received stage-matched intervention at different stages of behavior changes, and the SC group received only routine care. The intervention was based on the health action process approach theory and included risk perception, outcome expectancy, and self-efficacy. Questionnaires included the Self-Efficacy Measure for Sleep Apnea, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI). Data were collected at baseline and 1 and 3 months after home CPAP treatment, and hours of CPAP usage was also recorded at 1 and 3 months of follow-up. At 1 month, CPAP usage was 5.59 ± 0.56 h/night (mean ± SD) vs 5.28 ± 0.67 h/night in the SMC and SC groups, respectively (p = 0.016). At 3 months, CPAP usage was 5.65 ± 0.50 vs 5.26 ± 0.82 h/night in the SMC and SC groups, respectively (p = 0.006). Repeated ANOVA analysis demonstrated that risk perception, outcome expectancy, and self-efficacy in the SMC group were significantly higher than those of the SC group (p < 0.05). Moreover, the time × group interaction was significant for outcome expectancy and self-efficacy, indicating that the groups differed significantly in changes in outcome expectancy and self-efficacy over the three time points. There was a significant difference between the SMC and SC groups in terms of improvement in ESS (p < 0.001) and PSQI (p = 0.013) after 3 months of CPAP treatment. Stage-matched intervention could not only facilitate intention formation and enhance treatment self-efficacy but significantly improve CPAP adherence in OSA patients for the 3-month treatment.