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

Abstract

INTRODUCTION In New Zealand (NZ), access to public sleep services is limited to people deemed with the highest need. The prevalence of obstructive sleep apnoea (OSA) increases with age, but the symptoms and the treatment pathway is expected to differ for older compared to younger patients. This study explored the experience of older people regarding diagnosis and treatment services for OSA in order to inform considerations required in primary health and sleep services. METHODS Patients who were initiated on Continuous Positive Airway Pressure (CPAP) therapy at the age of 65 years or older were invited to one of three 1.5-h focus group discussions. In total, 16 patients attended; nine were accompanied by their spouse or partner. Discussions were semi-structured and explored experiences with the OSA pathway, from diagnosis through to long-term management. RESULTS Thematic analysis highlights the key symptoms of OSA. Patients' experiences with diagnostic and treatment services were generally positive. However, there was an overarching need for greater knowledge and follow up regarding OSA and CPAP therapy. Most patients were happy with CPAP treatment. Issues associated with long-term use, comfort and daily management were highlighted, and strategies used to overcome them discussed. DISCUSSION Focus groups reported similar experiences, positively endorsing the health value of OSA diagnosis and CPAP therapy. Mechanisms and resources are required at a primary healthcare level in order to raise awareness around sleep and aging, OSA and CPAP. This would aid earlier and more appropriate diagnosis and management of OSA and help overcome some of the gaps identified in this study.

Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

“…This knowledge comes mainly from the perspective of adult patients with COPD, pulmonary fibrosis, and OSA receiving CPAP and from their carers. These studies were conducted in five countries (three from Europe) [45,46,47,48,49,50,51,52,53]. Thus, this evidence may not completely apply to the experience of younger patients (including children) and that of their carers or to patients with other diseases and other treatment modalities (e.g., Bilevel Positive Pressure Airway, LTOT) and from other countries/continents.…”

“…Two studies explored the patient’s experience with LTOT [45,46], and the others assessed the patient’s experience with non-invasive ventilation [47,48,49,50,51]. These studies were conducted in the United States of America [45,47], New Zealand [48,49], the United Kingdom [50], Sweden [51], and Spain [46] and included both adult patients and carers. Two reviews were also found on the needs of patients with COPD and were also used in the present analysis [52,53].…”

“…Education: on the basis of the perspectives of patients, it is apparent that education is crucial for defining clear expectations about the treatment and motivating patient adherence. The main education topics raised by patients receiving respiratory therapies are related to disease self-management (e.g., COPD, OSA); physical effects and potential clinical benefits of the respiratory therapy; risks of not using the respiratory therapy; guidance on the use and function of equipment (e.g., continuous positive airway pressure (CPAP) devices, oxygen concentrators, how to use pulse oximeters and adjust flow with exertion); side effects and guidance on its management (skin protection, dry mouth, nasal congestion, irritated eyes); traveling with equipment; follow-up appointments; and assistance with financial elements (e.g., how to claim electricity costs) [45,46,49,50].…”

“…Training: formal training on appropriate equipment use has been suggested to be an important strategy for improving adherence [46,47,48,49,50,51]. Healthcare professionals need to introduce the device, explore possible practical problems, and give advice/help to solve these problems.…”

“…Healthcare professionals need to foster a non-judgmental environment in which patients have opportunities to ask questions, share concerns and feelings, feel listened to, and feel understood. This is particularly important following the initiation of therapy [47], as questions or concerns are more likely to arise during the first days or weeks of treatment [49,52]. These opportunities can arise during regular follow-up visits, scheduled follow-up phone calls, and through access to a 24-h hotline [47].…”