Continuous Positive Airway Pressure Acceptance Research Articles

Educational video demonstrating collapsibility of the upper airway during sleep improves initial acceptance of CPAP in patients with severe obstructive sleep apnea: a retrospective study.

We investigated whether an audiovisual educational video demonstrating collapsibility of the upper airway during sleep would influence initial continuous positive airway pressure (CPAP) acceptance among patients with severe obstructive sleep apnea. Between January 2017 and December 2018, a single-center retrospective study was conducted. We implemented an educational video demonstrating upper airway collapsibility during sleep in February 2018. We analyzed the medical records from 145 consecutive patients diagnosed with severe obstructive sleep apnea who underwent in-laboratory polysomnography both before and after implementing the educational video. Among them, 76 patients received standard care before the video's introduction (standard care group), and another 69 patients were managed after its implementation (video group). Baseline characteristics including age, body mass index, educational level, occupation category, comorbidities, Mallampati score, Epworth Sleepiness Scale score, apnea-hypopnea index, and sleep time with SpO2 below 90% were not significantly different between the 2 groups. Acceptance of CPAP following an in-laboratory overnight titration study was significantly higher in the video group (80%) than in the standard care group (57%) (P = .003). Multivariate regression analyses revealed that watching the video was a strong predictor of initial CPAP acceptance (odds ratio, 4.162; 95% confidence interval, 1.627-10.646; P = .004). Both sleep time with SpO2 below 90% (odds ratio, 1.020; 95% confidence interval, 1.002-1.038; P = .029) and sleep efficiency (odds ratio, 1.052; 95% confidence interval, 1.023-1.083; P < .001) were weak predictors for initial CPAP acceptance. At 12 months, adherence among those who accepted the CPAP treatment was similar between the 2 groups (78% vs 74%; P = .662). However, within the initial cohorts, a significantly higher proportion of patients in the video group (62%) were using CPAP at 12 months compared with the standard care group (42%) (P = .015). Among patients with severe obstructive sleep apnea, an educational video demonstrating upper airway collapsibility during sleep improved initial CPAP acceptance rates when compared with standard care. Tselepi C, Tsirves G, Exarchos K, etal. Educational video demonstrating collapsibility of the upper airway during sleep improves initial acceptance of CPAP in patients with severe obstructive sleep apnea: a retrospective study. J Clin Sleep Med. 2024;20(9):1423-1433.

Factors influencing continuous positive airway pressure adherence in elderly with obstructive sleep apnea.

Continuous positive airway pressure (CPAP) is the most effective treatment for symptomatic obstructive sleep apnea (OSA). The identification of actual predictors of CPAP adherence in real-world practice is essential since it enhances more individualized management for the patient. CPAP acceptance and adherence in elderly patients with OSA have the same challenges but the conclusion remains unclear. Therefore, our aim was to explore the factors influencing the adherence of CPAP in elderly OSA patients. The retrospective observational study was conducted from OSA patients' computerized medical records at Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University Hospital, Chiang Mai, Thailand between 2018 and 2020. Multivariable risk regression analyses were performed to evaluate the independent factors associated with CPAP non-acceptance and CPAP non-adherence. Of the 1,070 patients who underwent overnight polysomnography (PSG), 336 (31.4%) were elderly. Of 759 patients who accepted CPAP treatment, 221 (29.1%) were elderly, including 27 (12.2%) non-adherences, 139 (62.9%) adherences and 55 (24.8%) loss follow-up. Elderly patients with adverse attitudes toward CPAP use affected adherence to treatment [adjusted risk ratio (RR) =4.59, 95% CI: 1.79, 11.78, P=0.002]. Female was also associated with low CPAP adherence with adjusted RR =3.10 (95% CI: 1.07, 9.01), P=0.037. In our largest cohort to date, elderly OSA patients treated with CPAP over long-term follow-ups demonstrated that adherence rates were associated with personal life issues and adverse attitudes towards treatment as well as health problems. Female was also associated with low CPAP adherence. Therefore, in the elderly with OSA, the indication and treatment of CPAP should be customized individually, and if prescribed, regular monitoring to address noncompliance and tolerance should be considered.

Acceptability, adaptability and adherence to CPAP therapy among Aboriginal Australians with OSA - “The A5 study”

BackgroundStudies examining how Australian Aboriginal people will accept, adapt and adhere to interventions such as continuous positive airway pressure (CPAP) therapy in the management of obstructive sleep apnoea (OSA) are sparsely reported. MethodsIn this study, clinical, demographic, polysomnographic (PSG) and CPAP data were utilised to assess and predict acceptance and adherence to CPAP therapy among adult Aboriginal Australians diagnosed to have OSA. ResultsOf the 649 Aboriginal patients with OSA, 49% accepted to trial CPAP therapy. Patients who accepted to trial CPAP showed more severe OSA (65vs.35% with severe OSA), reported higher daytime sleepiness (median 10vs.9), and had a higher BMI (83vs.73% obese). Of those who accepted to trial CPAP, 62% adapted to therapy (used the device for more than 30 days). Patients who adapted had more severe OSA (71vs.54% with severe OSA), and were more likely to live in urban areas (63vs.40%). Of those who adapted, 32% were adherent to therapy. Adherent patients were more likely to live in urban areas (84vs.53%), though there was no difference in OSA severity between adherent and non-adherent patients. In multivariate models remote location and more severe OSA predicted CPAP acceptance, while urban location and more severe OSA predicted adaptation, and urban location and higher oxygen saturation nadir predicted adherence. ConclusionsAcceptance to trial CPAP therapy was observed in the presence of symptomatic and severe OSA. However, long term adherence to CPAP therapy was significantly influenced by patients’ residential location, with patients residing in remote/rural settings demonstrating significantly lower adherence rates.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

Management of Psychiatric Disorders in Patients with Respiratory Diseases.

The association of age with continuous positive airway pressure ventilation acceptance in an outpatient cohort of patients with obstructive sleep apnea.

This study examined the association between age and continuous positive airway pressure (CPAP) acceptance in a consecutive series of patients with obstructive sleep apnea being managed in a physician-led outpatient CPAP acclimatization program in Canberra, Australia. We performed a retrospective consecutive case series analysis of registry data collected from patients attending the Canberra Hospital PAP Acclimatization Clinic between 2011 and 2019. Data on patient demographics, diagnostic polysomnography results, CPAP device download parameters during acclimatization, and overall CPAP acceptance at the end of acclimatization were extracted from the Clinic Registry. Analysis of variance and chi-square were used to assess for associations between patient age, CPAP acceptance, and other clinical characteristics. Univariate and stepwise multiple logistic regression was used to identify predictors of CPAP acceptance. We found that 1,075 consecutive CPAP trials among 1,043 patients were eligible for inclusion. CPAP acceptance was lower in those aged > 75 years compared with those aged ≤ 75 years (odds ratio: 0.57; 95% confidence interval, 0.36-0.92; P = .02). Patients aged > 75 years had lower body mass index, had higher initial and final visit 95th percentile mask leak, and were less likely to be CPAP naïve. Using univariate regression, younger age, severe obstructive sleep apnea, obesity, shorter trial duration, more clinic visits, higher initial visit CPAP usage, and lower final visit mask leak were predictors of CPAP acceptance. In a multiple logistic regression model, younger age, severe obstructive sleep apnea, shorter trial duration, more clinic visits, higher first visit usage, and lower final visit leak predicted acceptance. Older age is associated with lower CPAP acceptance. The factors contributing to this association are unclear and require further investigation. Han M, Wee R, Shadbolt B, Huang H-CC. The association of age with continuous positive airway pressure ventilation acceptance in an outpatient cohort of patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(1):217-224.

Acceptance and Compliance of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea: Local Population Survey.

ObjectivesContinuous positive airway pressure (CPAP) compliance of > 4 hours per night has been considered acceptable to achieve clinical improvements in patients with obstructive sleep apnea (OSA). However, the factors determining CPAP adherence are unclear. This study aims to address the issue of acceptance and adherence to CPAP treatment in the Omani population and to determine the factors affecting adherence to CPAP.MethodsThis retrospective study included adult OSA patients who underwent polysomnography between January 2008 and December 2014 (n = 3046). Demographic information, Epworth Sleepiness Scale (ESS), apnea/hypopnea index (AHI), and desaturation events were collected from the sleep laboratory records. Subjects were grouped as CPAP users and CPAP non-users. CPAP users were divided into compliers (> 4 hours/night) and non-compliers (< 4 hours/night). Student’s t-test was used to find differences in CPAP users and non-users, compliers, and gender differences in CPAP users. The association of CPAP compliers and non-compliers with age, gender, AHI, ESS, and comorbidities were assessed using the chi-square test.ResultsOut of the 90.0% patients advised CPAP treatment, 34.7% came for regular CPAP follow-up. Total CPAP compliers were 59.3% (n = 274). The CPAP users had higher age, high ESS, baseline AHI, and more oxygen desaturation events than CPAP non-users (p < 0.010). Among the CPAP users, females were significantly older than males and had more oxygen desaturation events. CPAP compliers had significantly higher baseline AHI and more oxygen desaturation events. There was no association between CPAP compliance and age, gender, AHI, ESS, or comorbidities.ConclusionsCPAP users and compilers have severe OSA. CPAP acceptance and adherence are suboptimal and could not be predicted by age, gender, AHI, ESS, or comorbidities.

Acceptance of and six-month adherence to continuous positive airway pressure in patients with moderate to severe obstructive sleep apnea.

Continuous positive airway pressure (CPAP) is the most effective treatment for moderate to severe obstructive sleep apnea (OSA). Acceptance of and adherence to CPAP are crucial for optimal treatment outcomes. The aim of this study was to investigate the factors influencing patients' acceptance of and adherence to CPAP treatment. One hundred eighty-eight patients with moderate to severe OSA who had received CPAP titration from October 2017 to September 2018 were recruited. They were interviewed at 2weeks and at 6months to assess CPAP use and barriers to acceptance and adherence. One hundred fourteen patients (60.6%) accepted CPAP treatment. Disease severity, assessed by apnea-hypopnea index (AHI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.08), subjective satisfaction of titration (OR, 12.83; 95% CI, 3.83-42.99), initial intention of CPAP therapy (OR, 3.33; 95% CI, 1.05-10.51) and short-term home CPAP trial (OR, 9.40; 95% CI, 2.85-31.08) were associated with acceptance of CPAP treatment. Two-third of the 98 CPAP acceptors reported good CPAP adherence at 6months follow-up. Average hours of CPAP use per day for the first 2weeks (OR, 1.88; 95% CI, 1.28-3.04) and the global problems associated with CPAP use (OR, 0.82; 95% CI, 0.73-0.91) were independent predictors of the six-month CPAP adherence. Nearly 40% of patients with moderate to severe OSA did not accept CPAP treatment, and one-third of those CPAP acceptors had poor adherence to CPAP treatment. Improvement in disease awareness, comfortable titration experience, short-term home CPAP trial may be of help to increase CPAP acceptance and early experience with CPAP is important for long-term adherence. The differences in predicting factors for CPAP acceptance and adherence highlight the importance of focusing on specific aspects during the whole process management of OSA.

Predictors of Initial Acceptance of Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients After Intensive Educational-Behavioral Program

Background: Continuous positive airway pressure (CPAP) device therapy is the standard treatment for obstructive sleep apnea (OSA) to date. However, acceptance and adherence rate remained low. Recent study showed that educational and behavioral modification program can improve the efficacy of CPAP use.&#x0D; Objectives: To study rate of acceptance and its predictor factors of in patients with obstructive sleep apnea after participant in group modification behavior program.&#x0D; Methods: This prospective cohort study was conducted in 247 obstructive sleep apnea patients at Ramathibodi Sleep Disorders Center, Ramathibodi Hospital from February to July 2015. There were indicated for CPAP. Participating states spanning included awareness, motivating, demonstration, and trials of CPAP evaluated every week for 3 weeks.&#x0D; Results: Of 247 obstructive sleep apnea patients (62% male) were included with apnea-hypopnea index (AIH) (median [interquartile range], 41.5 [46.4]), and acceptance CPAP (85%). Factors influencing decision to use CPAP were severity of diseases (OR, 4.1; 95% CI, 1.2 - 13.9), triple trials (OR, 8.6; 95% CI, 2.1 - 35.4), and government reimbursement (OR, 8.1; 95% CI, 2.9 - 22.4).&#x0D; Conclusions: After educational and behavioral intervention, the CPAP acceptance rate were high among Thai patients with obstructive sleep apnea. This program should be encouraged for more widespread clinical practice.

The Clinical Impact of Systematic Screening for Obstructive Sleep Apnea in a Type 2 Diabetes Population-Adherence to the Screening-Diagnostic Process and the Acceptance and Adherence to the CPAP Therapy Compared to Regular Sleep Clinic Patients.

Obstructive sleep apnea (OSA) is a common disorder in Type 2 diabetes (T2D) patients further increasing their already high cardiovascular risk. As T2D patients typically not report OSA symptoms, systematic screening for OSA in this population is warranted. We aimed to determine the readiness of T2D patients to undergo screening and to compare their adherence to continuous positive airway pressure (CPAP) therapy with “regular” sleep clinic patients who typically seek medical advice on their own initiative. We therefore recruited 494 consecutive T2D patients and offered them OSA screening using home sleep monitoring (type IV device). All participants in high risk of moderate-to-severe OSA were recommended home sleep apnea testing (HSAT) followed by CPAP therapy. Patients were followed-up for 12 months and outcomes compared to 228 consecutive sleep clinic patients undergoing HSAT. Among 307 screened T2D patients, 94 (31%) were identified at high risk of moderate-to-severe OSA. Subsequently, 54 patients underwent HSAT, 51 were recommended, and 38 patients initiated CPAP (acceptance 75%). Among 228 sleep clinic patients, 92 (40%) were recommended and 74 patients initiated CPAP (acceptance 80%). After 1 year, 15 (39%) T2D and 29 (39%) sleep clinic patients showed good CPAP adherence (use ≥ 4 h/night ≥ 70% nights). In conclusion, 20 T2D patients needed to be screened in order to obtain one successfully treated patient. OSA screening in T2D patients identified 31% with moderate-to-severe OSA. Once diagnosed, their CPAP acceptance and adherence did not differ from sleep clinic patients. However, the reasons for the high dropout during the screening-diagnostic process impacting the overall success of the screening program need to be identified and addressed.

Barriers to acceptance and adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea: a report from Kermanshah province, western Iran.

PurposeContinuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). CPAP acceptance and adherence are critical issues for optimal treatment outcome. Identifying barriers to acceptance and adherence can improve intervention development and outcomes. This study aimed to investigate the barriers to CPAP acceptance/adherence in patients with OSA in western Iran.Patients and methodsPatients with OSA, who had been prescribed CPAP by the Sleep Disorders Research Center of Kermanshah University of Medical Sciences, were recruited. They were interviewed via telephone regarding acceptance (ie, CPAP use during the first 2 weeks) and adherence (ie, CPAP use 4 h/d for 70% of the nights per week). Barriers to acceptance and adherence were solicited.ResultsOut of a possible sample of 101, 97 patients (79 male) were reached and included in the study. They had a mean age of 48.76 years (SD =12.04) and mean apnea/hypopnea index score of 36.06 (SD =1.87). Patients were categorized into the following acceptance/adherence groups: nonacceptance (CPAP not purchased; 72.2%), poor adherence (5.2%), and adherent (22.7%). Inability to afford a CPAP device, perception of symptom reduction/no need for treatment, and dissatisfaction with treatment were among the most common reasons for nonacceptance and poor adherence.ConclusionCPAP acceptance and adherence in western Iran are low. Approximately 70% of the patients did not accept CPAP treatment (due to not obtaining the device) and 5% did not adhere. To improve acceptance/adherence, increased access (ie, reduced cost or increased insurance coverage) and enhanced education about the benefits of the treatment are recommended. Treatment monitoring via regular follow-ups may also prove beneficial.

Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial

ObjectiveTelemonitoring (TM) has been used in continuous positive airway pressure (CPAP)−treated patients to improve compliance, but results have been inconsistent. The purpose of this study was to assess the impact of TM on the delay to the first technical intervention after CPAP initiation. The impact of TM on mean compliance during the first 3 months of treatment was measured as a secondary outcome. MethodsPatients diagnosed with moderate to severe obstructive sleep apnea syndrome were prospectively included and randomized to receive usual care (UC) or TM. In both arms, an educational session was scheduled 1 month after CPAP initiation, and medical visits were planned after 1.5 and 3 months. In the TM arm, we added a universal TM unit (T4P) to the CPAP device. ResultsDelay to first intervention was significantly shorter in the TM group (29 ± 25 vs 47 ± 30 days, p = 0.02). The first intervention in the TM group was motivated by detection of problems by the TM system in 39% of patients. Compliance at 3 months was significantly better in the TM group (5.7 ± 1.6 vs 4.2 ± 1.9 h/night, p = 0.018). ConclusionThis is the first randomized study showing that TM reduces delay to first technical intervention in CPAP-treated patients. This early activation of troubleshooting was associated with improved compliance at 3 months. Since CPAP side effects at 1 month have been shown to predict lower 12-month CPAP compliance, TM seems to be an excellent tool for improvement of long-term CPAP acceptance.

Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system.

There is limited data on long term Continuous Positive Airway Pressure (CPAP) adherence in Southeast Asian countries. This is a prospective study on CPAP adherence among Obstructive sleep apnea (OSA) patients in a Southeast Asian privately funded healthcare system. Patients with moderate-severe OSA who had been initiated on CPAP at least one year previously were contacted for a scripted telephone interview to assess compliance and factors associated with CPAP adherence. Of 135 consecutive patients diagnosed to have moderate to severe OSA, 78 (57.8%) were initiated on CPAP treatment while 57 (42.2%) rejected CPAP upfront. 41 (52.6%) who initiated CPAP remained adherent at one year. OSA severity (AHI, ODI) and symptomatic improvement after CPAP were associated with better adherence. Presence of machine related side effects was associated with lower adherence. Inconvenience, cost and poor disease perception were reported as major barriers to uptake of CPAP therapy. In this Southeast Asian privately funded healthcare system, almost half of all patients with significant OSA rejected CPAP treatment upfront, but adherence among those who started CPAP is comparable to other reports. Challenges with CPAP acceptance as well as CPAP adherence need to be addressed to improve outcomes.

The Effect of Patient Neighborhood Income Level on the Purchase of Continuous Positive Airway Pressure Treatment among Patients with Sleep Apnea.

The cost of continuous positive airway pressure (CPAP) treatment for patients with low socioeconomic status may be an important barrier to successful treatment of obstructive sleep apnea under a copayment health care system. We evaluated an association between patient neighborhood income level and the purchase of a CPAP device under a cost-sharing health care insurance system. All adults who underwent a first diagnostic sleep study at St. Michael's Hospital (Toronto, ON, Canada) between 2004 and 2010 were included. Severity of obstructive sleep apnea was determined by the apnea-hypopnea index (AHI) and level of daytime sleepiness (by the Epworth Sleepiness Scale). Patient data were linked to provincial health administrative data from 1991 to 2013 to determine the purchase of CPAP equipment, comorbidities, neighborhood income, and rural status at baseline. Neighborhood income was categorized into quintiles, ranked from poorest (Q1) to wealthiest (Q5). Assuming that the majority of participants with severe obstructive sleep apnea (AHI > 30 events/h) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥ 10) would have been strongly recommended CPAP, we evaluated the association between patient neighborhood income and purchase of a CPAP device in this group via multivariable Cox regressions. Of the 695 participants with severe obstructive sleep apnea and excessive daytime sleepiness, 400 (58%) purchased a CPAP device. Patients who accepted CPAP were more likely to live in a higher-income neighborhood. Cumulative incidence of CPAP acceptance at 6 months was 43% for individuals in a low-income neighborhood (Q1) and 52% in combined higher-income neighborhoods (Q2-5) (P = 0.05). Controlling for sex and age, living in higher-income neighborhoods was associated with a 27% increased chance of accepting CPAP compared with the lowest-income neighborhood (hazard ratio Q2-5 vs. Q1, 1.27; 95% confidence interval, 0.98-1.64; P = 0.07). Living in an unfavorable neighborhood is not an obstacle to CPAP treatment among symptomatic patients with severe obstructive sleep apnea under a copayment health care system. However, a potential 27% improvement in CPAP acceptance associated with higher neighborhood income is not inconsequential. Also, the overall CPAP acceptance rate was relatively low, suggesting that obstacles other than finances are primarily responsible.

CPAP acceptance and compliance in sleep apnea patients in Oman

Introduction Obstructive sleep apnea (OSA) is a common sleep disorder affecting an average of 4% of men and 2% of women. Continuous positive airway pressure (CPAP) is the standard treatment for patients with OSA. CPAP compliance and acceptance are major problems among OSA patients and that requires a regular follow up and monitoring. This study is aimed to evaluate CPAP usage and compliance in our local population. Materials and methods Patients recommended for CPAP treatment following overnight polysomnography (PSG) at Sultan Qaboos University Hospital during the period 2008 to 2011 were reviewed. The data were collected from patients' medical records, Polysomnography reports and by contacting them by telephone call. Comparative statistics were done between years 2008–2009 and 2010–2011. Results Total PSGs done between years 2008–2011 were N =779 and CPAP was recommended for 429 (55%) patients. Only 229/429 patients could be contacted. 89 patients regularly using CPAP (39%) and out of these; 50 patients had bought CPAP and 39 received CPAP through a donation service. 47 patients were using CPAP (19%) with patients who bought their own CPAP. 24 (10%) patients received donated machines. The study also showed that 49 (20%) patients refused to use CPAP, 60 (24%) patients could not purchase CPAP (for financial reasons). Comparison was performed between 2008, 2009, and 2010, 2011 it showed significant improvements (33.33%) in patients who bought their own CPAP. (30.43%) and patients who received donated machines. Conclusion This study revealed that CPAP usage and acceptance has improved over the last two years in Omani sleep apnea patients. Acknowledgement Deepali Jaju, Mohammed Al-Abri.

Importance of CPAP school. Improving treatment adherence?

Gold standard treatment of obstructive sleep apneas (OSA) is with a Continuous positive airway pressure (CPAP) machine. Lack of adherence to CPAP is the major cause of treatment failure in OSA. Factors influencing CPAP acceptance are multi-factorial. One of the most important medical objectives is improving adherence. To determine whether installation of a CPAP device in a CPAP-school modifies final adherence, and analyze the factors associated with CPAP adherence at four months. Study undertaken at the Sleep Unit of a Tertiary University Hospital. All consecutive patients diagnosed with OSA that met indication for CPAP in a four month period were included. Anthropometric characteristics and baseline measures of disease severity were assessed. Subjects from another health area and those who had neurocognitive disorders or severe disease were excluded. Randomly, CPAP was installed at the CPAP school (intervention group) or at home (control group). The same protocol was used by the same group of selected nurses when installing the CPAP in both groups. CPAP adherence was assessed by memory cards in the machine. A multivariate linear regression model was built to determine factors associated with adherence. 166 patients were included; 49 of them were women (30%), mean age = 53 ± 10 years, BMI = 31 ± 3.4, and score on the Epworth scale = 13 ± 2.6. Intervention group consisted of 81 patients and the control group of 85. Age, Epworth Sleepiness Scale, motivation, BMI and OSA severity were similar in both groups ( p > 0.05). The intervention group had a higher number of patients with ⩽4 per hour rate ( p = 0.047) and a lower number rejected CPAP ( p = 0.001) than in the control group. In the treatment group the rate of use at the fourth month was about 4.8 ± 1.2 h while it was 3.7 ± 1.6 h ( p = 0.001) in the control group. A multiple linear regression model showed that intervention and ratio in the first month were variables independently associated with treatment adherence. Four months adherence showed significant correlation with rate of use during first month, Epworth Score, apneas–hypopneas index and intensity of intermittent hypoxia. In multivariate linear regression model (R2 = 0.632; p = 0.001) only ratio at first month and installation of device at CPAP-school were independent variables. Ratio at first month and school CPAP are essential to increase CPAP adherence. This is relevant as school CPAP increases adherence over 1 h and decreases rejection of CPAP. To Mrs. Inmaculada Jurado, a Linde nurse at CPAP school, for helping us to achieve this paper.

CPAP therapy in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea: does it offer a better quality of life and sleep?

The recent literature shows an increased incidence of obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF). On the other hand, there are no published studies related to continuous positive airway pressure (CPAP) treatment in this patient group. Our aim was to assess the effect of CPAP on sleep and overall life quality parameters in IPF patients with OSA and to recognize and overcome possible difficulties in CPAP initiation and acceptance by these patients. Twelve patients (ten males and two females, age 67.1 ± 7.2years) with newly diagnosed IPF and moderate to severe OSA, confirmed by overnight attended polysomnography, were included. Therapy with CPAP was initiated after a formal in-lab CPAP titration study. The patients completed the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes in Sleep Questionnaire (FOSQ), the Fatigue Severity Scale (FSS), the SF-36 quality of life questionnaire, and the Beck Depression Inventory (BDI) at CPAP initiation and after 1, 3, and 6months of effective CPAP therapy. A statistically significant improvement was observed in the FOSQ at 1, 3, and 6months after CPAP initiation (baseline 12.9 ± 2.9 vs. 14.7 ± 2.6 vs. 15.8 ± 2.1 vs. 16.9 ± 1.9, respectively, p = 0.02). Improvement, although not statistically significant, was noted in ESS score (9.2 ± 5.6 vs. 7.6 ± 4.9 vs. 7.5 ± 5.3 vs. 7.7 ± 5.2, p = 0.84), PSQI (10.7 ± 4.4 vs. 10.1 ± 4.3 vs. 9.4 ± 4.7 vs. 8.6 ± 5.2, p = 0.66), FSS (39.5 ± 10.2 vs. 34.8 ± 8.5 vs. 33.6 ± 10.7 vs. 33.4 ± 10.9, p = 0.44), SF-36 (63.2 ± 13.9 vs. 68.9 ± 13.5 vs. 72.1 ± 12.9 vs. 74.4 ± 11.3, p = 0.27), and BDI (12.9 ± 5.5 vs. 10.7 ± 4.3 vs. 9.4 ± 4.8 vs. 9.6 ± 4.5, p = 0.40). Two patients had difficulty complying with CPAP for a variety of reasons (nocturnal cough, claustrophobia, insomnia) and stopped CPAP use after the first month, despite intense follow-up by the CPAP clinic staff. Heated humidification was added for all patients in order to improve the common complaint of disabling nocturnal cough. Effective CPAP treatment in IPF patients with OSA results in a significant improvement in daily living activities based on the FOSQ, namely an OSA-specific follow-up instrument. Improvement was also noted in other questionnaires assessing quality of life, though not to a statistically significant degree, probably because of the multifactorial influences of IPF on physical and mental health. The probability of poor CPAP compliance was high and could only be eliminated with intense follow-up by the CPAP clinic staff.

A Multisite Randomized Trial of Portable Sleep Studies and Positive Airway Pressure Autotitration Versus Laboratory-Based Polysomnography for the Diagnosis and Treatment of Obstructive Sleep Apnea: The HomePAP Study

To test the utility of an integrated clinical pathway for obstructive sleep apnea (OSA) diagnosis and continuous positive airway pressure (CPAP) treatment using portable monitoring devices. Randomized, open-label, parallel group, unblinded, multicenter clinical trial comparing home-based, unattended portable monitoring for diagnosis and autotitrating CPAP (autoPAP) compared with in-laboratory polysomnography (PSG) and CPAP titration. Seven American Academy of Sleep Medicine (AASM) accredited sleep centers. Consecutive new referrals, age 18 yr or older with high probability of moderate to severe OSA (apnea-hypopnea index [AHI] ≥ 15) identified by clinical algorithm and Epworth Sleepiness Scale (ESS) score ≥ 12. Home-based level 3 testing followed by 1 wk of autoPAP with a fixed pressure CPAP prescription based on the 90% pressure from autotitration of PAP therapy (autoPAP) device (HOME) compared with attended, in-laboratory studies (LAB). CPAP acceptance, time to treatment, adherence at 1 and 3 mo; changes in ESS, and functional outcomes. Of 373 participants, approximately one-half in each study arm remained eligible (AHI ≥ 15) to continue in the study. At 3 mo, PAP usage (nightly time at pressure) was 1 hr greater: 4.7 ± 2.1 hr (HOME) compared with 3.7 ± 2.4 hr (LAB). Adherence (percentage of night used ≥ 4 hr) was 12.6% higher: 62.8 ± 29.2% compared with 49.4 ± 36.1% in the HOME versus LAB. Acceptance of PAP therapy, titration pressures, effective titrations, time to treatment, and ESS score change did not differ between arms. A home-based strategy for diagnosis and treatment compared with in-laboratory PSG was not inferior in terms of acceptance, adherence, time to treatment, and functional improvements. http://www.ClinicalTrials.gov; Identifier: NCT: 00642486.

Financial Incentive Increases CPAP Acceptance in Patients from Low Socioeconomic Background

ObjectiveWe explored whether financial incentives have a role in patients′ decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing.DesignLongitudinal interventional study.PatientsThe group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330–660; the financial incentive group paid a subsidized price of $55.ResultsCPAP acceptance was 43% greater (p = 0.02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3.43, 1.09–10.85), age (1.1, 1.03–1.17), AHI (>30 vs. <30) (4.87, 1.56–15.2), and by family/friends who had positive experience with CPAP (4.29, 1.05–17.51). Among average/high-income patients (n = 145) CPAP acceptance was affected by AHI (>30 vs. <30) (3.16, 1.14–8.75), living with a partner (8.82, 1.03–75.8) but not by the financial incentive. At one-year follow-up CPAP adherence was similar in the financial incentive and control groups, 35% and 39%, respectively (p = 0.82). Adherence rate was sensitive to education (+yr) (1.28, 1.06–1.55) and AHI (>30 vs. <30) (5.25, 1.34–18.5).ConclusionsMinimizing cost sharing reduces a barrier for CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients.

Motivational interviewing (MINT) improves continuous positive airway pressure (CPAP) acceptance and adherence: A randomized controlled trial.

Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with a new diagnosis of OSA. One hundred six Australian adults (69% male) with a new diagnosis of OSA and a clinical recommendation for CPAP treatment were recruited from a tertiary sleep disorders center. Participants were randomly assigned to receive either 3 sessions of a motivational interviewing intervention (MINT; n = 53; mean age = 55.4 years) or no intervention (control; n = 53; mean age = 57.74 years). The primary outcome was the difference between the groups in objective CPAP adherence at 1-month, 2-month, 3-month, and 12-month follow-ups. Fifty (94%) participants in the MINT group and 50 (94%) participants in the control group met all inclusion and exclusion criteria and were included in the primary analysis. The number of hours of CPAP use per night in the MINT group at 3 months was 4.63 hr and was 3.16 hr in the control group (p = .005). This represents almost 50% better adherence in the MINT group relative to the control group. Patients in the MINT group were substantially more likely to accept CPAP treatment. MINT is a brief, manualized, effective intervention that improves CPAP acceptance and objective adherence rates compared to standard care alone.

Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment.

To evaluate whether socioeconomic status (SES) has a role in obstructive sleep apnea syndrome (OSAS) patients' decision to accept continuous positive airway pressure (CPAP) treatment. Cross-sectional study; patients were recruited between March 2007 and December 2007. University-affiliated sleep laboratory. 162 consecutive newly diagnosed (polysomnographically) adult OSAS patients who required CPAP underwent attendant titration and a 2-week adaptation period. 40% (n = 65) of patients who required CPAP therapy accepted this treatment. Patients accepting CPAP were older, had higher apnea-hypopnea index (AHI) and higher income level, and were more likely to sleep in a separate room than patients declining CPAP treatment. More patients who accepted treatment also reported receiving positive information about CPAP treatment from family or friends. Multiple logistic regression (after adjusting for age, body mass index, Epworth Sleepiness Scale, and AHI) revealed that CPAP purchase is determined by: each increased income level category (OR, 95% CI) (2.4; 1.2-4.6), age + 1 year (1.07; 1.01-1.1), AHI ( > or = 35 vs. < 35 events/hr) (4.2, 1.4-12.0), family and/or friends with positive experience of CPAP (2.9, 1.1-7.5), and partner sleeps separately (4.3, 1.4-13.3). In addition to the already known determinants of CPAP acceptance, patients with low SES are less receptive to CPAP treatment than groups with higher SES. CPAP support and patient education programs should be better tailored for low SES people in order to increase patient treatment initiation and adherence.