Factors Influencing the Use and Nonuse of Continuous Positive Airway Pressure Therapy: A Comparative Case Study

Abstract

The rates of sustained use of continuous positive airway pressure (CPAP) therapy among adults with obstructive sleep apnea (OSA) appear consistently suboptimal, despite the efficacy of this treatment. Using semistructured interviews, this study identified facilitators and barriers toward CPAP therapy after treatment initiation among patients with OSA. A purposive sample of eight patients representing extreme differences in CPAP use was recruited from a multisite sleep disorders clinic at a tertiary health center. Perceived physical, psychological, and social factors were found to influence both CPAP use and nonuse. It was revealed that the way patients feel about themselves influences the ways in which they manage their OSA with or without CPAP. This study underlines the necessity of working with patients and their families to create social environments that are both accepting and supportive of patients with OSA.

Does personality play a role in continuous positive airway pressure compliance?

“…The prevalence rate of depression in OSA compared to people without OSA is roughly 33%, which may be a direct consequence of sleep deprivation or could be an indirect consequence of social effects caused by the disorder [13], as long-term sleep deprivation can adversely affect mood [3]. Individuals with OSA tend to have a higher BMI than the normative population [15] and obesity is associated with an increased risk of depression as well [13]. …”

“…This phenomenon may be due to Type D personalities having a high external locus of control ( e.g. believing their health is determined by external forces, not the internal self) or minimising their symptoms, thereby not considering treatment to be necessary [1–3, 15]. …”

“…believing they have control over their health) are more likely to adhere to CPAP treatment [1–3, 15]. This is due to internalising and following advice received from sleep specialists, having the ability not to perseverate on treatment side-effects, and displaying high self-efficacy [2].…”

Effect of the CPAP-SAVER Intervention on Adherence Among Adults with Newly Diagnosed Obstructive Sleep Apnea

“…The literature review resulted in three qualitative studies that explored subjective norm-related concepts in the OSA-CPAP population. A comparative case study was conducted using semistructured interviews to explore factors influencing the use and nonuse of CPAP (Ayow et al, 2009). Dickerson and Akhu-Zaheya (2007) used a hermeneutic phenomenological approach to gather narratives for interpretive analyses to understand the lifechanges experiences by individuals diagnosed with OSA while adjusting to CPAP use.…”

“…CPAP, in general, is not viewed by individuals as a pleasant experience, especially since it is an intrusion into their peaceful time of sleep (Aloia, 2011). CPAP users report a stigma associated with CPAP use, specifically related to CPAP's side effects, users' beliefs that the machine is cumbersome to use, and users' beliefs that CPAP is embarrassing to wear (Ayow, Paquet, Dallaire, Purden, & Champagne, 2009;Shapiro & Shapiro, 2010;Willman, Igelstrom, Martin, & Asenlof, 2012). CPAP users report many side effects, including discomfort from the pressure, mask problems, claustrophobia, machine noise, nasal congestion, mouth and nasal dryness, eye irritation, skin abrasions and ulcerations, and tooth and jaw pain Salepci et al, 2013;Sawyer, Gooneratne, et al, 2011;Willman et al, 2012), many of which deter its use.…”