A Tailored Intervention for PAP Adherence: The SCIP-PA Trial.

OBJECTIVE/BACKGROUND: Positive airway pressure (PAP) is highly efficacious treatment but nonadherence is prevalent with little improvement over the last 15 years. Tailored interventions show promise for promoting adherence to other treatments. The study objective was to examine feasibility and acceptability of a tailored intervention to promote PAP adherence. PARTICIPANTS: The convenience sample met inclusion criteria: newly diagnosed OSA; treatment-naïve; ≥ 18 years. EXCLUSION CRITERIA: previous obstructive sleep apnea (OSA) diagnosis and treatment; new psychiatric diagnosis; use of oxygen/bilevel PAP; secondary sleep disorder. Adults (n = 118) were randomized to tailored intervention (TI; n = 61) or usual care (UC; n = 57); application of a priori exclusion criteria resulted in 30 participants per assignment who were middle-aged (51.3 ± 11.1 years) adults (70% male) with severe OSA (apnea hypopnea index [AHI], 35.9 ± 25.2). METHODS: Randomized, double-blind, single-site pilot controlled trial. A multiphased tailored intervention targeting social cognitive perceptions of OSA-PAP treatment was delivered at four intervals. Descriptive analysis, group differences, and self-efficacy change scores by t-test, and thematic analysis of acceptability data are reported. RESULTS: One-week PAP use among TI was 35 min greater than UC condition (p = 0.20; Cohen's d = 0.336). Treatment use decreased at 1 month and 3 months (NS). Per-protocol delivery of face-to-face intervention delivery was 100% but lower for telephone intervention delivery. Personalized approach was valued by participants. CONCLUSIONS: A tailored intervention approach is acceptable to participants and feasibly implemented in a clinical sleep center setting. The intervention effect size at 1 week is consistent with other educational PAP adherence interventions but was not sustained; further pilot testing is warranted to address pilot RCT limitations.

Claustrophobic tendencies and continuous positive airway pressure therapy non-adherence in adults with obstructive sleep apnea.

OBJECTIVES: (1) Determine claustrophobia frequency in adults with obstructive sleep apnea (OSA) after first CPAP night; (2) determine if claustrophobia influences CPAP non-adherence. BACKGROUND: Claustrophobia is common among CPAP-treated OSA adults yet few studies have examined the problem. METHODS: Secondary analysis of prospective, longitudinal study of OSA adults (n = 97). CPAP-Adapted Fear and Avoidance Scale (CPAP-FAAS) collected immediately after CPAP titration polysomnogram. PRIMARY OUTCOME: objective CPAP use at 1 week and 1 month. RESULTS: Sixty-three percent had claustrophobic tendencies. Females had higher CPAP-FAAS scores than males. FAAS ≥ 25, positive score for claustrophobic tendencies, was influential on CPAP non-adherence at 1 week (aOR = 5.53, 95% CI 1.04, 29.24, p = 0.04) and less CPAP use at 1month (aOR = 5.06, 95% CI 1.48, 17.37, p = 0.01) when adjusted for body mass index and CPAP mask style. CONCLUSION: Claustrophobia is prevalent among CPAP-treated OSA adults and influences short-term and longer-term CPAP non-adherence. Interventions are needed to address this treatment-related barrier.

Is inconsistent pre-treatment bedtime related to CPAP non-adherence?

Lack of adherence to continuous positive airway pressure therapy (CPAP) limits the effectiveness of treatment of obstructive sleep apnea (OSA). We hypothesized that an irregular bedtime would be negatively related to regular use of CPAP treatment. If so, modifying bedtime schedule may address the persistent problem of inconsistent CPAP use in adults with OSA. In a prospective longitudinal study, we examined whether inconsistent self-reported bedtime before initiation of CPAP treatment, operationalized as bedtime variability, was (1) different among those adherent (≥4 hours per night) and non-adherent to CPAP treatment at 1 week and 1 month; and/or (2) was related to 1-week and 1-month CPAP use when other variables were accounted for. Consecutively recruited newly diagnosed OSA adults (n = 79) completed sleep diaries prior to CPAP treatment. One-week and 1-month objective CPAP use data were collected. Pre-treatment bedtime variability was different among CPAP non-adherers and adherers at 1 month and was a significant predictor of non-adherence at 1 month in multi-variable analyses. The odds of 1-month CPAP non-adherence were 3.5 times greater in those whose pre-treatment bedtimes varied by >75 minutes. Addressing sleep schedule prior to CPAP initiation may be an opportunity to improve CPAP adherence.