Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions

Abstract

Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of motivational interventions to increase adherence to Continuous Positive Airway Pressure (CPAP) among patients with Obstructive Sleep Apnea Syndrome (OSAS) and of their specific aspects and strategies by assessing adherence measures.Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the concepts of “obstructive sleep apnea syndrome,” “continuous positive airway pressure,” “motivational intervention,” and “adherence.” Rigorous inclusion criteria and screening by at least two reviewers were applied. Data were extracted to address the review aims and were presented as a narrative synthesis.Results: Search for databases produced 11 randomized controlled trials, all including naïve CPAP users. Findings showed that motivational interventions were more effective than usual care and educational programs in increasing adherence to CPAP, despite results were not always maintained over time across studies.Discussion: To our knowledge, this is the first scoping review of the literature aimed to explore the characteristics and impact of motivational interventions to promote adherence to CPAP in patients with OSAS. More research providing a detailed description of motivational strategies, and testing of their association with positive treatment outcomes via both direct and indirect measures are needed to increase awareness on active mechanisms of change.

Study protocol of a randomized controlled trial of motivational interviewing-based intervention to improve adherence to continuous positive airway pressure in patients with obstructive sleep apnea syndrome: The MotivAir study

“…Specifically, based on the results of previous research (e.g., Sparrow et al, 2010 ; Aloia et al, 2013 ; Dantas et al, 2015 ; see for a review: Rapelli et al, 2021 ), participants assigned to the experimental group are expected to show increased clinical and psychological parameters compared to the control condition. Indeed, according to MI theoretical assumptions, positive changes in the post-treatment levels of readiness to change and perceived self-efficacy will result in increased adherence to behavioral change plans.…”

“…Motivational Interviewing (MI) is often used in healthcare settings to increase motivation to change and self-efficacy in patients with chronic illnesses ( Pietrabissa et al, 2012 , 2013 , 2015 ; Pietrabissa, 2018 ; Nedjat-Haiem et al, 2019 ; Scott et al, 2019 ), and has a demonstrated positive impact in increasing adherence to CPAP among patients with OSAS ( Miller and Rollnick, 2002 , 2013 ; Rapelli et al, 2021 ). Consistent with several models of behavior change, including the transtheoretical model of change (TMC, Prochaska and DiClemente, 1983 ), this approach is mainly aimed at addressing the individuals’ inner ambivalence to change.…”

Assessing the needs and perspectives of patients with obesity and obstructive sleep apnea syndrome following continuous positive airway pressure therapy to inform health care practice: A focus group study

“…In fact, previous studies showed that patient education on the consequences of poor adherence is not sufficient, and in some cases, it is detrimental because it forced the decision to not adhere to the treatment. Conversely, as suggested by studies conducted with a motivational interviewing approach (e.g., Aloia et al, 2004;Sparrow et al, 2010;Dantas et al, 2015; see for a review: Rapelli et al, 2021a), working in line with the values and orientating them toward the health goal could be more effective. Among acknowledged facilitators to CPAP use were being informed and followed up by the medical team, but also receiving support from both the professionals and other patients.…”

“…However, the success of this treatment relies on treatment adherence, which is frequently suboptimal in this population of patients (Weaver and Grunstein, 2008;Rapelli et al, 2021a;Gabryelska et al, 2022).…”

Precision Medicine in Adult Obstructive Sleep Apnea and Home Diagnostic Testing: Caution in Interpretation of Home Studies Without Clinician Input Is Necessary

“…The management of non-adherence with CPAP is another area in which a personalized approach is critical. Educational, behavioral, and troubleshooting interventions may be useful both before and during the initiation of CPAP to mitigate the chance of non-adherence ( 22 , 23 ). Other strategies should be tailored to the individual's concerns, for example comfort, air leak, extent of humidification, and preference for nasal or oral mask.…”