Improve CPAP Adherence Research Articles

Effectiveness of behavioral and psychosocial interventions for continuous positive airway pressure adherence among patients with obstructive sleep apnea: A systematic review and meta-analysis

BackgroundContinuous positive airway pressure (CPAP) therapy is the treatment of choice for Obstructive Sleep Apnea (OSA) syndrome; however, interventions to improve CPAP adherence are still inconclusive. ObjectiveThis study aimed to examine the effectiveness of behavioral and psychosocial interventions on CPAP adherence. MethodsThe PRISMA guidelines and JBI approach for Systematic Review and Meta-analysis were used. Participants included 1) newly diagnosed patients with OSA, naive to CPAP treatment; 2) any type of behavioral and/or psychosocial intervention delivered via individual or group level; 3) CPAP adherence as an outcome. Two reviewers independently selected studies, evaluated their methodological quality, and extracted data. ResultsCritical appraisal was conducted on 34 of the 1657 studies, with 18 RCTs included in the final review. Telemonitoring increased the mean nightly hour of CPAP use compared to standard care (WMD = 0.76, 95 % CI = 0.31–1.20, p = 0.001, I2 = 0 %, moderate certainty of evidence). Positive results were discovered in Motivational Enhancement Therapy (MET) (WMD = 1.22, 95 % CI = 0.28–2.16, p = 0.011, I2 = 65 %, very low degree of certainty of evidence). The combined effects of cognitive therapy and education on CPAP adherence were inconclusive. Behavioral/supportive interventions improved mean nightly CPAP use in both the short term (WMD = 1.49, 95 % CI = 0.16–2.81, p = 0.029, I2 = 30 %, very low certainty of evidence) and long-term follow-up (WMD = 1.67, 95 % CI = 1.55–1.79, p = 0, I2 = 0 %, very low certainty of evidence). ConclusionsTelemonitoring improved the mean nightly hour of CPAP utilization compared with standard care. Motivational Enhancement Therapy (MET) had the most significant effect on long-term adherence.

P134 Sleep Laboratory contact in adults commencing CPAP: a post-hoc analysis of the AHEAD trial

Abstract Background CPAP used for >4hrs/night effectively treats obstructive sleep apnoea(OSA), however CPAP adherence is often poor. A randomised control trial from our department demonstrated improved CPAP adherence at 12 months in patients receiving video education (VE), compared with standard of care education (SOCE) at CPAP commencement. This follow-on study aimed to evaluate 12-month clinic utilisation of patients in the AHEAD trial, hypothesizing that increased unscheduled contact by patients in the intervention arm may contribute to improved CPAP adherence. Methods Post-hoc analysis of data from the AHEAD trial was performed. The AHEAD trial included 195 patients recruited from a large trial protocol and randomised to either SOCE or SOCE+VE. Demographics including age, gender, education level and socioeconomic indices were collected. CPAP usage was assessed at 2-, 6-, and 12-months post randomisation. Adequate adherence was defined as usage >4hours/night. Further data on number of scheduled and unscheduled visits at 12-months post randomisation was collected. The primary outcome was number of unscheduled visits in intervention vs control arm. Progress to date Study groups were well-matched at baseline. The proportion with adequate CPAP usage at 12mths was higher in the VE group (33, 33% versus 48, 50% p=0.01). Preliminary analysis suggests there are no significant differences in number of unscheduled visits at 12-month follow up between SOCE vs SOCE+VE (mean0.29 vs 0.43 p=0.18). Further analysis will investigate predetermined subgroups – including low educational level / socioeconomic status. Intended outcome and impact This study will inform strategies to improve CPAP adherence in patients with OSA.

A telemonitoring system to support CPAP therapy in patients with obstructive sleep apnea: a participatory approach in analysis, design, and evaluation

BackgroundContinues positive airway pressure (CPAP) therapy is a gold standard treatment for moderate to severe cases of OSA (obstructive sleep apnea). The present research aimed to describe the analysis, design, and evaluation of a telemonitoring system to improve CPAP adherence in patients afflicted with OSA.MethodsThe telemonitoring system was developed in five phases. In the exploratory phase, the body of related literature was reviewed. Then a need analysis was conducted through a focus group discussion with sleep medicine specialists and sales company representatives and an interview with patients. The third phase involved data integration. Then the content and system development were done based on the previous phases. Finally, usability and functionality tests were used to evaluate the system.ResultsThe exploratory phase and the needs analysis were conducted by four sleep medicine specialists, two medical informatics specialists, six key figures of the sales companies, two system developers, and 46 patients in different phases. Based on the results obtained from the data integration phase, the telemonitoring system involved three main parts: a patient’s application, a doctor’s portal, a selling companies’ portal (operator’s portal) along with facilitating software for patients to send the CPAP data. Usability and functionality tests were given to 7 and 10 patients, respectively. The total number of usability issues reported by users in the evaluation process was 18, with an average of 2.5 issues per user. The installation problems, disrupted links and improper playing of videos were the main functionalities problems that were solved.ConclusionThe telemonitoring system, as a means of communication between patients, doctors, and selling companies, can be used to support patients clinically and technically. It has the potential to improve CPAP adherence in patients with OSA.

559 Effect of Weekly Text Message Feedback on Continuous Positive Airway Pressure Adherence in Pediatric Obstructive Sleep Apnea

Abstract Introduction Continuous Positive Airway Pressure (CPAP) is an effective treatment for Obstructive Sleep Apnea (OSA) in children. However, adherence to CPAP therapy is often suboptimal. CPAP telemonitoring with automated feedback messaging has been shown to improved adherence in adults with OSA, but has not been widely studied as an intervention for children with OSA. This pilot study was conducted to investigate if feedback messaging could similarly improve CPAP adherence in children. Methods Pediatric OSA subjects (ages 11–17) with poor CPAP compliance or newly prescribed CPAP were selected from an outpatient Sleep Medicine clinic to receive weekly text messages with scripted feedback on CPAP adherence. Patients already meeting adherence goals were excluded from the study. Parental consent was obtained and participants were given the option to have text messages sent to parents or directly to the patient. Adherence was monitored over a four-month intervention period and compared to pre-intervention usage as a self-matched control. Total hours of use per month and numbers of days used per month were collected through daily remote CPAP monitoring. Average hours per use and average daily use per 30-day period were additional adherence measurements calculated. Data was analyzed using two-tailed paired T-tests with level of significance set at p<0.05. Results There was no significant change in CPAP adherence (p>.05) after initiation of weekly feedback messaging for the five patients included in the study. No participant, before or after intervention, met the Medicare definition of compliance (≥4hr nightly use for ≥ 70% of nights) and average adherence declined following intervention. Conclusion In a small pilot study, weekly feedback text messaging did not improve CPAP adherence in pediatric patients with OSA. This finding contrasts with larger studies in adult patients with OSA that have demonstrated improved CPAP adherence with automated feedback messaging. With the increasing use of telemedicine for CPAP follow-up, new strategies to successfully utilize this approach in the pediatric population may be needed. Support (if any) None.

363 The Apnea and Insomnia Research (AIR) Trial: An Interim Report

Abstract Introduction Many sleep apnea patients suffer from comorbid insomnia disorder. Although cognitive behavioral insomnia therapy (CBTI) is recommended as the first line insomnia treatment for such patients, access to trained providers of this treatment remains limited. The current study is testing he efficacy of an online CBTI among CPAP treated sleep apnea patient with comorbid insomnia. Methods Patients enrolled in this trial complete baseline measures and then are randomized to either an online version of Cognitive Behavioral Insomnia Therapy (CBTI) or no additional treatment beyond their CPAP therapy (CTRL). After 8 weeks of treatment all patients are reassessed. The current report considers changes in scores on the ISI and Epworth Sleepiness Scale (ESS) as well as average minutes of nightly CPAP use from pre-treatment to the end of the initial 8 weeks of online treatment relative to the no treatment CTRL. The sample for this report included the first 276 participants enrolled in this trial (mean age = 56.5±12.5 yrs; 58.7% females). Results Those receiving online CBTI showed greater reductions in their ISI scores from baseline to the end of the initial 8-week treatment phase than did those in the CTRL group (p = .0001). Average ISI score improvements among those receiving online CBTI moved patients from moderately severe insomnia to mild insomnia symptoms. In contrast, no differences were noted between the online CBTI and CTRL groups in regard to pre- to post-treatments changes on the ESS (p= .2541) scores or amount of CPAP use (p = .4383). Conclusion Whereas online CBTI does not seem to reduce daytime sleepiness or improve CPAP adherence among patients with comorbid sleep apnea and insomnia, it appears to be an effective intervention for reducing insomnia severity for this patient group. Support (if any) National Heart. Lung and Blood Institute Grant # 1R01HL130559-01A1

683 Comparison of Telemedicine and In-Person Psychotherapy for CPAP Adherence in a population of Veterans

IntroductionObstructive sleep apnea (OSA) is the second most common sleep disorder among Veterans and carries risk of serious health complications when untreated. The gold standard for OSA treatment is Positive Airway Pressure (PAP). However, adherence to PAP therapy is chronically low. Interventions to enhance adherence include education, practical support, and psychotherapy. Cognitive behavioral therapy and motivational interviewing have been shown to improve CPAP usage by approximately 1 hour per night. Telemedicine-delivered CPAP education and telemonitoring-with-feedback has demonstrated improved adherence in patients with OSA. Our study evaluated the effectiveness of a telemedicine group psychotherapy intervention for Veterans diagnosed with OSA and found to be nonadherent to CPAP therapy. The intervention is delivered in four weekly 60-minute sessions.MethodsWe identified a cohort of 29 patients who participated in the intervention via telemedicine from April 2020 - September 2020 (Telemedicine Psychotherapy cohort). The cohort was compared to a historical control of 35 patients who participated in the in-person group psychotherapy from April 2019 - September 2019 (In-Person Psychotherapy cohort). Through retrospective chart review, we analyzed baseline and post-intervention data from both cohorts. Demographics collected included age, sex, BMI, ethnicity, zip code, as well as medical and mental health comorbidities. Data collected from the medical record included: OSA severity, pre- and post-psychotherapy 90-day average nightly CPAP usage (in minutes), number of psychotherapy classes attended (out of 4) and number of sleep clinic visits at 90-days post-psychotherapy. We used descriptive statistics to provide summary data of this sample and t-test to evaluate Veteran’s average CPAP usage per night and number of sleep clinic visits at 90-days post-psychotherapy between cohorts.ResultsCompared to a cohort of in-person group psychotherapy to improve CPAP adherence, a telemedicine-based cohort demonstrated improvement in 90-day average nightly CPAP usage by an average of 76 minutes per night. (p=0.08) Additionally, patient engagement with the sleep clinic at 90 days following completion of telemedicine psychotherapy was significantly higher compared to in-person psychotherapy (p<0.001).ConclusionIn a haphazardly-collected convenient sample of veterans during the COVID-19 pandemic, telemedicine psychotherapy led to improved CPAP usage. Veterans who underwent telemedicine intervention also significantly increased engagement with the sleep clinic.Support (if any):

Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome.

Because of the prevalence of extreme obesity in the United States, there has been an increase in prevalence of obesity hypoventilation syndrome (OHS). There is limited information on the characteristics and pattern of positive airway pressure (PAP) adherence in patients with OHS compared with eucapnic patients with obstructive sleep apnea (OSA). This article discusses in detail the impact of PAP therapy on outcomes in patients with OHS, compares adherence between continuous PAP and noninvasive ventilation in OHS, and compares PAP adherence in patients with OHS to patients with moderate to severe OSA enrolled in clinical trials designed to improve CPAP adherence.

0510 The Apnea and Insomnia Research (AIR) Trial: A Preliminary Report

Abstract Introduction Many sleep apnea patients suffer from comorbid insomnia disorder. Although cognitive behavioral insomnia therapy (CBTI) is recommended as the first line insomnia treatment for such patients, access to trained providers of this treatment remains limited. The current study is testing he efficacy of an online CBTI among CPAP treated sleep apnea patient with comorbid insomnia. Methods Patients enrolled in this trial complete baseline measures and then are randomized to either an online version of Cognitive Behavioral Insomnia Therapy (CBTI) or no additional treatment beyond their CPAP therapy (CTRL). After 8 weeks of treatment all patients are reassessed. The current report considers changes in scores on the ISI and Epworth Sleepiness Scale (ESS) as well as average minutes of nightly CPAP use from pre-treatment to the end of the initial 8 weeks of online treatment relative to the no treatment CTRL. The sample for this report included the first 170 participants enrolled in this trial (mean age = 56.5±12.5 yrs; 60.1% females). Results Those receiving online CBTI showed greater reductions in their ISI scores from baseline to the end of the initial 8-week treatment phase than did those in the CTRL group (p = .0009). Average ISI score improvements among those receiving online CBTI moved patients from moderately severe insomnia to mild insomnia symptoms. In contrast, no differences were noted between the online CBTI and CTRL groups in regard to pre- to post-treatments changes on the ESS (p= .3771) scores or amount of CPAP use (p = .8053). Conclusion Whereas online CBTI does not seem to reduce daytime sleepiness or improve CPAP adherence among patients with comorbid sleep apnea and insomnia, it appears to be an effective intervention for reducing insomnia severity for this patient group. Support National Heart. Lung and Blood Institute Grant # 1R01HL130559-01A1

Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial

Background Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. Methods Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. Results A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. Conclusions In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. Trial registration number ClinicalTrials.gov Identifier: NCT02553694.

0379 A Randomized Controlled Trial Of CBT-I and CPAP For Comorbid Insomnia and OSA: Initial Findings from the MATRICS Study

The purpose of this study was to compare the efficacy of three treatment sequences using CPAP with or without CBT-I for the treatment of comorbid insomnia and obstructive sleep apnea (COMISA). One-hundred and twenty-one adults (52.50% female, mean age=50.00) with COMISA were randomized to receive one of three treatment models using a partial factorial design: CBT-I followed by CPAP (Model A), CBT-I concurrent with CPAP (Model B), and CPAP only (Model C). CPAP was delivered following standard procedures for in-lab CPAP titration and home set-up with a third-party vendor. CBT-I was delivered in four individual sessions. Primary outcomes were CPAP adherence across the first 90 days of use and global measures of insomnia (Insomnia Severity Index; ISI) and sleep quality (Pittsburgh Sleep Quality Index; PSQI). Planned comparisons were conducted on those who received CBT-I+CPAP (Models A and B combined) versus CPAP only (Model C) using Wilcoxon signed ranks test and linear mixed models. No significant differences were found between the CPAP+CBT-I groups versus the CPAP only group on percent of nights used (Median=48.65% vs Median=71.10%, p=.29), minutes used per night (Median=232.87 vs Median=186.06, p=.21) or percentage of participants who were regular CPAP users (≥4 hours on ≥70% of nights during 30-day period; 37.50% vs 36.59%, p=.92). For mild OSA (AHI≥5 and <15), the CPAP+CBT-I groups used CPAP on a greater percentage of nights compared to the CPAP only group (Median=30.00% vs Median=5.00%), which approached significance (p=.05). A significant main effect was found for improvement in the ISI (p<.0001) and PSQI (p<.0001) but the interaction was not significant for either measure. These findings indicate that patients with COMISA show improvements in self-reported global measures of insomnia and sleep quality across all treatment models. Although no significant benefits were found for those who received CBT-I+CPAP in the overall sample, there were indications that CBT-I might improve CPAP adherence among those with mild OSA. This study was supported by grant R01HL114529 from the National Institutes of Health.

Prevalence, Associated Clinical Features, and Impact on Continuous Positive Airway Pressure Use of a Low Respiratory Arousal Threshold Among Male United States Veterans With Obstructive Sleep Apnea.

Determine the prevalence of, and clinical features associated with, a low respiratory arousal threshold (ArTH) among patients with obstructive sleep apnea (OSA), and to assess whether a low ArTH is associated with reduced long-term CPAP use. Cross-sectional and longitudinal analyses were performed in an observational study conducted among 940 male Veterans with OSA. Data for clinical characteristics, polysomnography characteristics, and long-term (5 ± 2 years) CPAP use were obtained from clinical records. Logistic regression was used to assess the associations between low ArTH and clinical features, including regular CPAP use. A low ArTH was observed in 38% of participants overall, and was more common among nonobese (body mass index < 30 kg/m2) patients (55%). In adjusted analyses, increasing body mass index (per 5 kg/m2) and antihypertensive medication use were negatively associated with low ArTH, with odds ratio (OR) (95% confidence interval [CI]) of 0.77 (0.69, 0.87) and 0.69 (0.49, 0.98), respectively. Conversely, increasing age (per 10 years) and antidepressant use-OR (95% CI) 1.15 (1.01,1.31) and 1.54 (1.14,1.98), respectively-were positively associated with low ArTH. Nonobese patients with low ArTH were less likely to be regular CPAP users-OR (95% CI) 0.38 (0.20, 0.72)-in an adjusted model. Low ArTH is a common trait among Veterans with OSA and is more frequent among those who are older and nonobese and those taking antidepressants, but is less frequent among patients taking antihypertensive medications. A marked reduction of long-term CPAP use in nonobese patients with low ArTH highlights the importance of understanding a patient's physiologic phenotype for OSA management, and suggests potential targets to improve CPAP adherence. A commentary on this article appears in this issue on page 713.

Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial

BackgroundSuboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover,...

1192 ADAPTATION OF A BRIEF MOTIVATIONAL ENHANCEMENT EDUCATION PROGRAM DURING CPAP INITIATION TO AN ACADEMIC PUBLIC SLEEP CLINIC

A brief motivational enhancement education program (BMEEP) developed in Hong Kong is a pragmatic intervention that may improve CPAP adherence (Lai, CHEST 2014). We adapted BMEEP to a Los Angeles County public sleep clinic (BMEEP-LA) and evaluated implementation and effectiveness. Our hypotheses: 1) Patient and staff acceptance of BMEEP-LA would be high; 2) Patients who received BMEEP-LA would achieve greater CPAP adherence compared to usual care. BMEEP-LA was adapted to accommodate staffing, appointment availability, workflow and language/cultural factors, while maintaining core features of video education, motivation interviewing and negative message framing. BMEEP-LA encounters were provided by a Sleep NP-specialist trained in motivational interviewing. During 3/15/2016 - 7/15/2016, 78 newly-diagnosed patients completed BMEEP-LA. Acceptance was evaluated qualitatively by semi-structured patient and staff interviews. Electronic CPAP adherence data at 1 and 3 months were collected and compared to: 1) a case-matched control group that received usual care during 1/1/2014 - 12/31/2015 (informal education during CPAP set-up); and 2) published data from the BMEEP trial. Comparisons among groups were tested by student’s t-test and binomial approximation. The BMEEP-LA and control groups were equivalent by age, gender, racial/ethnic, BMI, Epworth score, subjective sleepiness and AHI. Compared to the BMEEP trial, BMEEP-LA had similar age and AHI ranges, but lower proportion of men (50% vs 84%), dissimilar racial/ethnic composition (70% Hispanics/0% Chinese vs 100% Chinese) and higher mean BMI (37.4 vs 28.6). Interviews with patients and staff indicated high acceptance of BMEEP-LA. Adherence indicators were similar to the BMEEP trial at 1 and 3 months. Compared to controls, BMEEP-LA adherence indicators were similar at 1 month, but higher at 3 months (82 +/- 23% vs 66 +/- 33% days used (p=0.003), 4hr 47min vs 3 hr 36 min daily use (p=0.003), 63 +/- 23 vs 49 +/- 33% days with >4 hr use (p=0.016), and 36 vs 23% patients with >70% days of >4hr use (p=0.072)). Despite having been developed for Chinese patients, BMEEP was successfully adopted in a Los Angeles County sleep clinic with disparate demographic/social-cultural characteristics and engendered long-term CPAP adherence improvement over usual care. none

A Randomized Crossover Trial of a Pressure Relief Technology (SensAwake™) in Continuous Positive Airway Pressure to Treat Obstructive Sleep Apnea.

Objectives/Background Improving adherence to CPAP devices is crucial to reduce the long-term morbidity associated with OSA. SensAwake is a unique pressure relief technology that aims to promptly reduce the pressure upon sensing irregular respiration indicative of wakefulness. The purpose of this study was to compare adherence and sleep-quality outcomes in patients treated by CPAP with and without SensAwake technology. Methods Participants with moderate-to-severe OSA were randomized to use CPAP devices with or without SensAwake (4 weeks) before crossing over. Results Sixty-five patients completed both arms of the trial. There were no statistically significant differences in CPAP adherence with or without SensAwake over the study period (SensAwake ON 272.67 ± 17.06 versus SensAwake OFF 289.09 ± 15.24; p = 0.180). SensAwake reported a significantly lower system leak, 90th percentile leak, and time spent with excessive (>60 L/min) leak. Subgroup analysis suggested a trend towards improved adherence in patients with moderate-to-severe insomnia when using SensAwake. Conclusions Using SensAwake incurred benefit in terms of reduced leaks; however, SensAwake did not improve CPAP adherence or objective sleep quality. Further studies should investigate the accuracy of observed trends towards increased adherence using SensAwake among patients with OSA and insomnia.

Polysomnograph Chart View by Patients: A New Educational Strategy to Improve CPAP Adherence in Sleep Apnea Therapy

CPAP is currently the treatment of choice for obstructive sleep apnea syndrome, but therapy adherence is poor. Many educational trials have been proposed to increase CPAP adherence. We tested the hypothesis that polysomnograph chart viewing by patients would improve CPAP adherence. A controlled parallel group study was performed with 206 newly diagnosed obstructive sleep apnea syndrome patients, randomized into 2 groups (n = 103 each): standard support group, and educational support group. Each educational support group subject viewed 2 consecutive polysomnograms on the computer screen: the first recorded during a standard diagnostic overnight polysomnography, and the second during a full-night polysomnography with nasal CPAP. The subject's attention was drawn only to the flow and oxyhemoglobin saturation curves. Clinical outcomes were assessed via polysomnography at CPAP initiation and after 1, 3, and 12 months. After 12 months of CPAP, 76% of the educational support group and 52% of the standard support group returned for a follow-up visit (P < .001). Statistical significance had already been reached after 1 and 3 months. Moreover, CPAP use (measured as hours of use per night) was higher in the educational support group at each control visit. Polysomnograph chart viewing by obstructive sleep apnea patients can increase CPAP adherence, as evaluated by rate of return for the follow-up visit and mean nightly CPAP use.

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Adherence to CPAP therapy is low in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The purpose of the present study was to evaluate the utility of measures of sleep architecture and sleep continuity on the CPAP titration study as predictors of both short- and long-term CPAP adherence. 93 patients with OSAHS (RDI 42.8 ± 34.3/h) underwent in-laboratory diagnostic polysomnography, CPAP titration, and follow-up polysomnography (NPSG) on CPAP. Adherence to CPAP was objectively monitored. Short-term (ST) CPAP adherence was averaged over 14 days immediately following the titration study. Long-term (LT) CPAP adherence was obtained in 56/93 patients after approximately 2 months of CPAP use. Patients were grouped into CPAP adherence groups for ST (< 2 h, 2-4 h, and > 4 h) and LT adherence (< 4 h, > 4 h). Sleep architecture, sleep disordered breathing (SDB) indices, and daytime outcome variables from the diagnostic and titration NPSGs were compared between CPAP adherence groups. There was a significant relationship between ST and LT CPAP adherence (r = 0.81, p < 0.001). Neither ST nor LT adherence were related to demographic variables, baseline severity of untreated SDB, sleep architecture, or measures of daytime impairment. Good CPAP adherence groups had significantly lower %N2 and greater %REM on the titration NPSG. A model combining change in sleep efficiency and change in sleep continuity between the diagnostic and titration NPSGs predicted 17% of the variance in LT adherence (p = 0.006). These findings demonstrate that characteristics of sleep architecture, even on the titration NPSG, may predict some of the variance in CPAP adherence. Better sleep quality on the titration night was related to better CPAP adherence, suggesting that interventions to improve sleep on/prior to the CPAP titration study might be used as a therapeutic intervention to improve CPAP adherence.

The Quest to Improve CPAP Adherence—PAP Potpourri is Still Not the Answer, but More Research is Needed

Al-though we both agree that addressing psychosocial barriers to positive airway pressure (PAP) adherence is important, we are unmoved by the arguments presented to support their contention that newer PAP modalities can improve PAP usage for all patients. To date, studies attempting to demonstrate improved compliance with new PAP modalities have been, at best inconsistent in their fi ndings (reviewed in Antonescu-Turcu).

Driving On “Auto”: Hands-On is More Effective Than Hands-Free

Driving On “Auto”: Hands-On is More Effective Than Hands-Free

The Quest to Improve CPAP Adherence—PAP Potpourri is Not the Answer

The Quest to Improve CPAP Adherence—PAP Potpourri is Not the Answer

Adherence to CPAP in Patients With Obstructive Sleep Apnea in a Chinese Population

CPAP is the first choice for most patients with obstructive sleep apnea (OSA), but the adherence to CPAP is suboptimal. The purpose of this study was to assess the adherence to CPAP therapy of Chinese OSA patients with CPAP therapy. Two-hundred ten patients who had been diagnosed with OSA and had experienced CPAP titration trial as prescribed were enrolled in this study. Subjects were identified by reviewing our Snoring and Sleep Apnea Unit's records. The patients were interviewed by telephone and were asked to assess their CPAP use time. Those who said their CPAP use time was less than 4 h/d for 70% of the nights per week were questioned about their reasons for non-adherence. Seventeen patients were lost to follow-up. One-hundred ninety-three patients participated in our survey. Patient demographics included male/female (162/31), mean ± SD age (51.91 ± 10.10 y), and mean apnea-hypopnea index (59.99 ± 21.51 events/h). At the time of the interview (59 ± 32 months after initial titration trial), 100 of 193 patients (51.8%) were still using CPAP, 29 of 193 patients (15.0%) had abandoned CPAP after using it for a period, and 64 of 193 patients (33.2%) had never commenced therapy after titration. The most common reasons cited by the patients for the poor adherence were they were not able to acclimatize to the CPAP during the titration night, they did not perceive the need or the benefits of the treatment, or found it troublesome to use CPAP every night. The CPAP adherence is low in Tianjin, China. Only one half of these patients remained adherent to the treatment, and the other one half of these patients either never initiated the treatment or had abandoned CPAP use. To improve CPAP adherence, the medical staff should pay attention to making the titration trial a comfortable first CPAP experience for the patients. It is also very important to give the patients education and support about CPAP use in the follow-up, especially early on in this treatment.