Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence

Abstract

Study Objectives: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder associated with a myriad of sequelae. OSAHS is effectively treated with continuous positive airway pressure (CPAP) therapy. However, fewer than 50% of patients are compliant with their CPAP therapy prescriptions. The current study sought to explore an integrated, biopsychological approach to CPAP adherence among experienced CPAP users. Methods: We performed a retrospective, cross-sectional analysis of a cohort of veterans with a diagnosis of OSAHS (n = 191) who were prescribed CPAP therapy and returned for adherence download at the Miami VA Sleep Clinic. The relationships between biomedical characteristics (e.g., CPAP pressure, selfreported sleepiness, and change in sleep efficiency) and psychological factors (e.g., self-efficacy beliefs and psychological diagnoses) and objectively measured CPAP use were examined to determine whether psychological factors moderated the relationships between biomedical characteristics and CPAP adherence. Results: Hierarchical regression analyses predicting CPAP adherence (adjusting for time since CPAP prescription, age, education, prescribed CPAP pressure, daytime sleepiness, changes in sleep efficiency with CPAP, and psychiatric conditions) revealed the following: (1) CPAP self-efficacy and CPAP pressure were positively related to adherence, and (2) CPAP self-efficacy moderates the relationship between CPAP pressure and CPAP adherence. Conclusions: There was no relationship between CPAP pressure and adherence in individuals with low self-efficacy beliefs. However, for individuals with high self-efficacy beliefs, there was a significant positive relationship between CPAP pressure and adherence. Self-efficacy beliefs appear to be a prime target for focused interventions aimed at improving CPAP adherence among those individuals with higher pressure prescriptions. I NTRO DUCTI O NObstructive sleep apnea-hypopnea syndrome (OSAHS) is a very common clinical condition. Population-based estimates suggest that approximately 20% of adults, or one in five, meet the criteria for at least mild OSAHS, based on an apnea-hypopnea index ≥ 5.1 OSAHS can be effectively treated with continuous positive airway pressure (CPAP) therapy.2,3 However, adherence with treatment recommendations is relatively low. 4 We sought to examine previously described biomedical and psychological factors associated with CPAP adherence, as well as investigate whether psychological factors (i.e., self-efficacy beliefs) might modify the association of biomedical characteristics and CPAP adherence.Identification of predictors of CPAP adherence is critically important given the many unwanted negative consequences of untreated OSAHS, such as deficits across multiple cognitive domains, 5,6 when viewed in context of the extremely high nonadherence rates associated with CPAP therapy. Approximately 50% of patients prescribed CPAP are completely noncompliant with therapy recommendation at 1 y. 4 In addition, 15% to 30% of patients with...

Reversal of PAP Failure With the REPAP Protocol

“…However, new technology enhanced comfort; and, greater comfort resulted in enhanced adaptability and use, which aligns with a rationale to make PAP more user-friendly to improve self-efficacy and ultimately increase adherence. 2,3,8,48 These findings may be especially relevant to psychiatric patients with OSA/upper-airway resistance syndrome who comprised the predominant phenotype in our sample and for whom vulnerability to expiratory pressure intolerance appears more pronounced. 26,30 Practically, newer models of care involving home testing for OSA diagnosis and auto-titration devices may also be applied to rescue PAP failure cases of lesser complexity, 11 notwithstanding the potential confounds in the assessment and treatment of respiratory effort-related arousals exhibited in either diagnosed upperairway resistance syndrome cases or as residual breathing events in patients with OSA who are titrated suboptimally.…”

“…Scant sleep literature reports on the value of repeat titrations, and even less research comments on a role for re-titrations in rescuing PAP failure cases. [3][4][5][6][7][8][9][10] In PAP failure (defined as cessation or rejection of PAP use), there is no evidence to suggest that such patients are routinely offered re-titrations in the sleep laboratory to SEE THE RELATED EDITORIAL ON PAGE 515 restart therapy. Rather, in the current health-care climate for sleep medicine, sleep professionals are trending toward home testing, auto-adjusting PAP devices, and objective data downloads.…”

Specific insomnia symptoms and self-efficacy explain CPAP compliance in a sample of OSAS patients

“…Self-efficacy can be evaluated with a dedicated self-report questionnaire called SEMSA (Self-Efficacy in Sleep Apnea) [ 17 ], standard clinical instrument often used to evaluate psychological factors related to OSAS and CPAP. Indeed, the impact of self-efficacy on CPAP compliance as evaluated by the SEMSA has been confirmed in several studies [ 8 , 13 , 14 , 16 , 18 – 22 ].…”

Perceived Effectiveness, Self-efficacy, and Social Support for Oral Appliance Therapy Among Older Veterans With Obstructive Sleep Apnea

“…These results are concerning since factors such as self-efficacy and social support are determinants of adherence to other types of sleep apnea therapies, such as positive airway pressure therapy. 19, 20 Our results suggest that although oral appliance therapy may be an attractive alternative to positive airway pressure therapy because it is transportable and easy to use, many older patients prescribed oral appliance therapy may have unfavourable expectations and perspectives towards oral appliance therapy, which could negatively impact adherence. Whether younger, female, and non-veteran patients would have similar beliefs and expectations is unclear.…”