An Update on Behavioural Interventions for Improving Adherence with Continuous Positive Airway Pressure in Adults

Abstract

Obstructive sleep apnoea (OSA) is a common sleep disorder which if left untreated results in considerable physical and psychological co-morbidity and mortality. With the development of continuous positive airway pressure (CPAP), an effective treatment was available to counteract the partial and complete airway closures, hypoxia and sleep fragmentation. Technological advances in CPAP devices improved the interface between machine and man, reduced noise levels and improved many aspects of the treatment process. Yet, with all these advancements over the last 35 years, adherence to CPAP remains low. There are a number of underlying factors in the poor uptake and discontinuation of treatment. Previous CPAP adherence interventions are discussed along with behavioural programmes which have emerged in the last 3 years. Of importance are the insights gained from emerging qualitative research in this area to enable a better understanding of patient perceptions and how these continue to impact on adherence rates.

Sleep Health: An Opportunity for Public Health to Address Health Equity

“…Future research should explore the hypothesis that specific OSA phenotypes, particularly those who present with more severe OSA and those with daytime sleepiness, may derive the greatest cardiovascular benefits from CPAP treatment ( 44 ). Furthermore, behavioral strategies to support the uptake of and compliance with treatments for OSA require further investigation ( 32 ). Finally, short-term studies focused on interventions to extend sleep duration and/or improve sleep quality suggest that improving sleep health holds promise as a strategy to reduce cardiovascular risk ( 51 ).…”

The effect of a change from face-to-face to remote positive airway pressure education for patients with sleep apnoea during the coronavirus disease-2019 pandemic: a prospective cohort study

“…A cross-sectional online survey-based study on adults living through the COVID-19 pandemic in UK between May and June 2020 showed that 65.2% of their 843 participants reported an impact on their mental health, significantly more sleep symptoms, and concern about their sleep (32). The higher prevalence of psychiatric comorbidities in our cohort (17.1% versus 5.7%, P=0.034, Table 1), may have introduced a selection bias in our study, as psychological factors may have an impact on individual patients' motivation to adhere to therapy (33). Having said that, a psychiatric co-morbidity was not a significant factor in our regression model (P=0.057).…”

Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults

“…This section extends an earlier review of behavioural interventions to improve PAP adherence 102 . It focusses on new approaches that have emerged in the last 4 years and explores their impact and practicality.…”