Controlled, prospective trial of psychosocial function before and after continuous positive airway pressure therapy

Abstract

The aim of the study was to investigate psychosocial function before and after continuous positive airway pressure (CPAP) therapy, and establish the determinants and consequences of objective CPAP use.In a prospective, parallel-group study, changes in psychosocial scores were compared with conservative management or CPAP therapy for the sleep apnoea/hypopnoea syndrome (SAHS). Patient/partner couples from the top (CPAP treated, n=44) or bottom (conservatively treated, n=25) of a CPAP waiting list rated marital satisfaction (evaluation and nurturing relationship issues, communication and happiness (ENRICH), behavioural questionnaire), health/functional status (Short-Form-36 Health Survey, functional outcomes of sleep questionnaire) and sleepiness (Epworth sleepiness scale). Both groups9 ratings at baseline were completed while on conservative therapy.Baseline variables did not differ between groups. At follow-up, all seven summary psychosocial scores were statistically better in CPAP-treated patients, effect sizes (ES) ranging from moderate (0.5 SD: marital satisfaction) to very large (w1.0 SD: patients health, functional status and sleepiness scores). Scores in conservatively-treated patients deteriorated to a small or moderate degree (ES -0.2--0.7 SD), while those in the CPAP-treated group improved to a larger degree (0.3-1.3 SD). Baseline polysomnographical and psychosocial scores, including marital satisfaction, did not predict objective CPAP use (rv0.3). CPAP use was modestly correlated (r=0.3-0.6) with improvement in all psychosocial areas.Continuous positive airway pressure produced statistically and clinically significant psychosocial improvements, some of large magnitude, in psychosocial function. Determinants of usage were not identified, but benefits and usage were positively correlated. Eur Respir J 2001; 18: 996-1002. Symptoms of the sleep apnoea/hypopnoea syndrome (SAHS) impact on many aspects of the daily behaviour and function of a patient, affecting marital and family relationships [1][2][3], work efficiency and income [1,4], activity level [4][5][6][7] and general health and functional status [5,[8][9][10][11][12][13][14][15][16][17]. Controlled, prospective clinical trials employing validated psychosocial outcomes [12][13][14][15][16][17] have documented improvements in sleepiness and general health/functional status after continuous positive airway pressure (CPAP) therapy, but there have been no prospective controlled trials of changes in marital satisfaction. Quantitative comparisons of the magnitude of therapeutic effects across these related psychosocial areas are scanty.A prospective, controlled, parallel-arm study of psychosocial function after CPAP therapy, incorporating validated outcome measurements of marital satisfaction, general health/functional status and sleepiness was therefore conducted. The primary aims of the study were to compare changes in psychosocial function in CPAP-treated patients with those in conservatively-treated patients, and to compare the magnitudes of ...

Health belief model predicts adherence to CPAP before experience with CPAP

“…Other studies report no effect of ESS score prior to treatment on determining CPAP compliance [13,33]. However, studies assessing changes in patient perceptions following treatment initiation have found that an improved ESS score often predicts current CPAP use [9,17,31]. Thus, the present study supports research suggesting that initial ESS score, along with many other biomedical indices of disease severity, are inconsistent early predictors of CPAP adherence.…”

“…Recent studies have begun to investigate the utility of psychological models in the prediction of CPAP acceptance and subsequent adherence [13,[15][16][17][18][19]. Patients begin to develop expectations and beliefs regarding OSA and CPAP treatment even before taking the treatment home [20].…”

Adherence and Subthreshold Adherence in Sleep Apnea Subjects Receiving Positive Airway Pressure Therapy: A Retrospective Study Evaluating Differences in Adherence Versus Use

“…Sleep medicine professionals are focused on encouraging greater PAP use and no doubt incorporate naturalistic approaches aligned with patients' learning curves, but adherence rules may interfere with this general practice model of care for select patients. In the real world, given that PAP benefits accrue during a variable time line, 60 like so many medications, the concept of use may provide a more pragmatic clinical tool in patient management, and speculatively, a use framework may ultimately lead to greater compliance.…”

Changes in emotional state of bed partners of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation: a pilot study

“…Despite wellfounded impact of CPAP treatment on the quality of life of the patients, there is still little understanding regarding the significance of these changes in emotional functioning of their spouses. The most frequent symptoms of OSAHS patients-daytime sleepiness, fatigue, and cognitive impairment-may not only limit patients' everyday functioning, but also undermine their relations with the family [15,17]. Our study emphasizes the possible reciprocity between the changes in the emotional well-being of patients and their bed partners.…”