Continuous positive airway pressure treatment for obstructive sleep apnoea: Maori, Pacific and New Zealand European experiences

Abstract

INTRODUCTION: Continuous positive airway pressure (CPAP) is an effective treatment of obstructive sleep apnoea (OSA), but can be limited by poor adherence. In New Zealand (NZ), ethnicity has been shown to be a predictor of CPAP adherence. This study aimed to explore Maori, Pacific and NZ European patients’ experience of CPAP treatment. METHODS: Patients identifying as Maori, Pacific, or NZ European ethnicity referred for CPAP treatment for OSA attended separate, 1.5-hour group discussions facilitated by a health care worker of the same ethnic group, using an interview template. Thematic analysis was applied to the discussion transcripts independently by two investigators, following published guidelines. FINDINGS: Five Maori, five Pacific, and eight NZ Europeans participated (mean age 47, range 30–71 years, mean ± standard deviation CPAP adherence 6.32 ±1.25 hours/night). Patients in all three groups reported that they had little knowledge of OSA or CPAP prior to treatment initiation. All groups identified barriers to treatment (both at the CPAP initiation phase and long term), reported feelings of being ‘overwhelmed’ with information during the initial CPAP education session, and discussed the importance of successful role models. Family and friends were generally reported as being supportive of CPAP therapy. CONCLUSION: The three groups all reported similar initial CPAP experiences, highlighting access barriers to publicly funded assessment and treatment pathways, and sleep health knowledge as key issues. Educational resources to improve access, enable self-management, and increase community awareness of OSA would help overcome some of the issues identified in this study. KEYWORDS: Continuous positive airway pressure; obstructive sleep apnea; ethnic groups; focus groups

From diagnosis to long-term management: the experiences of older New Zealanders with obstructive sleep apnoea

“…to our knowledge, this is the first qualitative study exploring the experience of older CPaP patients. Our findings support previous research with younger groups 19,22 while adding insight into the knowledge, experience and expectations of older patients. a broad range of themes were raised; these were grouped within three networks concerning the underlying symptoms of OSa, the variable nature of the pathway from diagnosis to management, and the effect that CPaP has on quality of life.…”

“…[19][20][21] Focus groups with New Zealanders with an average age of 47 years (30-71 years) helped identify thematic differences between ethnicities, as well as what patients considered strengths and weaknesses of their local sleep services when recently established on CPaP therapy. 22 However, documented experiences of older patients are lacking. Further research is required to better understand the experience of diagnosis and management of OSa for older patients, as well as to identify factors affecting acceptance of the current NZ services.…”

Experiences of noninvasive ventilation in adults with hypercapnic respiratory failure: a review of evidence

“…Evident throughout all the studies was the fact that when patients are started on NIV treatment, they usually have difficulties and troubles in becoming accustomed to the machine. These difficulties are related to significant air leaks, feelings of claustrophobia, aerophagia, presence or risk of facial injuries and respiratory distress [35,36,38,51].…”

“…The need for information among NIV patients with acute respiratory failure is well documented in most of the studies. Evidence from these studies suggest that when people with acute respiratory failure become ill, as seen in other illnesses, they develop much interest in knowing more about their condition, how it will be managed and the impact that will have on their wellbeing [25,35,36,39,41,46]. It is also evident from the studies that information is regarded by patients as a means to feel empowered and in control [22, 37-39, 41, 52].…”

“…Nevertheless, it is also interesting to note that NIV patients are very particular with the amount of information that they wish to receive; for instance, some participants in the study by SHOUKRY et al [32] felt that they were being bombarded with "too much" information, which they thought was not necessary, especially at a time where they were still assimilating their diagnosis. The findings of BAKKER et al [36] and LEMOIGNAN and ELLS [45] suggest that patients do not want information about their treatment before it is needed to make decisions, because information tends to discourage them. Furthermore, the studies revealed that the positivity aspect of information was an issue rated more highly by patients than by healthcare professionals.…”