RationaleLack of awareness about OSA as a disease in the society and patients attitude towards OSA and CPAP therapy as treatment has been highlighted in the majority of Indian studies as attributable to non-compliance of CPAP therapy in OSA patients. The evidence strongly suggests that initial experience with CPAP appears to be important, reinforcing the need for early education and support in these patients. Optimum compliance requires frequent follow-up and effective interventions which can be achieved with intensive counseling. MethodsWe performed a systematic qualitative analysis to find out the intensive counseling strategies to improve CPAP compliance in OSA patients by a 3-tiered search strategy 1. Search Engine (Google) 2. Database Search (PubMed, Google Scholar) 3. Searching the references. ResultsDepending on the literature search, we have formalized the intensive counseling strategies to improve CPAP compliance in OSA patients: 1. Counseling to assess the patient's knowledge of CPAP therapy in OSA through various modes like video, podcasts, education leaflets, phone calls, CPAP support group. 2. Understanding the attitude of the patient to CPAP therapy by addressing the facts like the health benefit of CPAP, cost factor, and comfort factor. 3. Discussing that there are no alternatives like definitive medical and surgical options as traditionally available for the majority of the disease management in India. 4. Counselling and educating the bed partner's perception of symptom-related treatment response. 5. Counselling in allaying the anxiety of using a CPAP mask. 6. Addressing social stigma and occupational barriers that may exist otherwise. 7. Early Cognitive behavioral therapy interventions for effective patient compliance. 8. Intensive follow-up during the first week of treatment and addressing problems immediately by a phone call or consultation, because intensively supported group which identified the reasons for poor compliance within the first week of therapy, had higher compliance than the standard support group. In the Indian setup hence we propose 3 tier intensive counseling strategy involving: 1. Sleep clinician-highlighting the importance of CPAP therapy, 2. CPAP therapist-addressing to use and troubleshoot CPAP, 3. CPAP distributor-counseling whilst selling /renting the CPAP and advising on tips to maintain it. ConclusionIntensive counseling strategies for improving CPAP compliance should be a multidisciplinary team (3 tier counseling strategy). Setting up a robust follow-up protocol will aid in understanding where the patients are falling short of instructions. Well-designed larger studies in this aspect are required to formulate the best counseling protocol.
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