Abstract
Long-term adherence to continuous positive airway pressure (CPAP) is low among patients with obstructive sleep apnea (OSA). The potential role of “habit” in sustaining adherence to CPAP use has not been studied. This study aimed to establish the relevance of habit to CPAP adherence, via validation of an adaptation of the Self-Report Habit Index (the CPAP Habit Index-5; CHI-5). Analyses focused on the homogeneity, reliability, and factor structure of the CHI-5 and, in line with theoretical predictions, its utility as a predictor of long-term CPAP adherence in middle-aged patients with OSA. A prospective longitudinal design was used. 117 patients with objectively verified OSA intended for CPAP treatment were recruited. Data was collected via clinical examinations, respiratory recordings, questionnaires, and CPAP devices at baseline, 2 weeks, 6 months, and 12 months. The CHI-5 showed satisfactory homogeneity interitem correlations (0.42–0.93), item-total correlations (0.58–0.91), and reliability (α = 0.92). CHI-5 data at 6 months showed a one-factor solution and predicted 63% of variance in total CPAP use hours after 12 months. Based on the satisfactory measurement properties and the high amount of CPAP use variance it explained, the CHI-5 can be seen as a useful tool in clinical practice.
Highlights
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder where repeated episodic collapses of the upper airways during sleep cause apneas and/or hypopneas
The self-report habit index (SRHI) is comprised of 12 items concerning three characteristics of habit: 8 items relating to aspects of automaticity (e.g., “Behaviour X is something I do without thinking”), 3 items concerning frequency (e.g., “Behaviour X is something I do frequently”), and 1 item that focuses on the relevance of the habit to self-identity (e.g., “Behaviour X is typically ‘me”’) [29]
The selected items were discussed by a multiprofessional expert panel consisting of three physicians specialized in sleep medicine, three nurses working primarily with continuous positive airway pressure (CPAP) treatment, and a behavioural scientist, as well as two nurse researchers with experience of obstructive sleep apnea syndrome (OSAS)
Summary
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder where repeated episodic collapses of the upper airways during sleep cause apneas and/or hypopneas. The resulting sleep fragmentation can cause daytime symptoms, including sleepiness, headaches, and cognitive dysfunction. This condition is termed obstructive sleep apnea syndrome (OSAS) [1]. Apart from the short-term negative consequences due to disturbed breathing, a growing body of evidence indicates that OSAS is a risk factor for hypertension, cardiac failure, stroke [2, 3], and occupational. The current treatment of choice is continuous positive airway pressure (CPAP) [4]. Adherence to CPAP treatment is important since sufficient use can eliminate apneas completely and improve sleep quality, excessive daytime sleepiness, and quality of life for both patients and partners. CPAP treatment can reduce morbidity and mortality in cardiovascular diseases, as well as consumption of health care resources [2]
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