Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome

Baratta, Francesco; Pastori, Daniele; Bucci, Tommaso; Fabiani, Marco; Fabiani, Valerio; Brunori, Marco; Loffredo, Lorenzo; Lillo, Rossella; Pannitteri, Gaetano; Angelico, Francesco; Ben, Maria Del

doi:10.1016/j.sleep.2017.09.032

Cited by 71 publications

(56 citation statements)

References 32 publications

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“…There is controversy and lack of agreement as to the best predictors of adherence to CPAP therapy in patients with OSA. Some variables, such as sleepiness, age, gender and OSA severity, have been reported as predictors in several studies (Baratta et al., ; Campos‐Rodriguez et al., ; Collen et al., ; Gagnadoux et al., ; Kohler et al., ; Krieger et al., ; Meurice, ; Pelletier‐Fleury et al., ; Sin et al., ; Sucena et al., ). In our study, the only baseline variable associated with poorer adherence at both cut‐off points was the presence of a previous stroke.…”

Section: Discussionmentioning

confidence: 99%

“…As in other long‐term therapies, adherence to CPAP is essential to attain any of its beneficial effects, but it is also difficult to achieve. Adherence rates range between 30% and 85% depending on the criteria used to define adherence, the duration of the follow‐up and the patient profile (Baratta et al., ; Florés et al., ; Furukawa et al., ; Jacobsen et al., ; Kohler et al., ; Krieger et al., ; McArdle et al., ; Pelletier‐Fleury et al., ; Sin et al., ). Patients coming from sleep clinics may have better adherence than those recruited from cardiovascular settings, because the former seek medical assistance for their sleep disorder and are usually more symptomatic than the latter (Chai‐Coetzer et al., ).…”

Section: Discussionmentioning

confidence: 99%

“…Although there is agreement to consider 4 hr per night as the minimum cut‐off point, some studies have shown that a better adherence may be needed for cardiovascular outcomes, particularly in non‐sleepy patients (Barbé et al., ). Moreover, the predictors of adherence to CPAP are still not well known and vary from one study to the next (Baratta et al., ; Campos‐Rodriguez et al., ; Collen, Lettieri, Kelly, & Roop, ; Gagnadoux et al., ; Kohler et al., ; Krieger et al., ; McArdle et al., ; Meurice, ; Pelletier‐Fleury et al., ; Sin et al., ; Sucena, Liistro, Aubert, Rodenstein, & Pieters, ).…”

Section: Introductionmentioning

confidence: 99%

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Good long‐term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea

Campos‐Rodríguez

Navarro-Soriano

Reyes-Núñez

et al. 2019

Journal of Sleep Research

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Although adequate adherence is paramount in achieving the beneficial effects of continuous positive airway pressure therapy in patients with obstructive sleep apnea, long‐term adherence and the variables involved in continuous positive airway pressure compliance in patients with resistant hypertension and obstructive sleep apnea are yet unknown. We conducted a prospective, multicentre, observational study in 177 patients recruited from hypertensive units with resistant hypertension confirmed by means of 24‐hr blood pressure monitoring (blood pressure ≥ 130 and/or ≥ 80 mmHg, despite taking at least three antihypertensive drugs or < 130/80 mmHg with > 3 drugs) and obstructive sleep apnea (apnea–hypopnea index ≥ 5 in a respiratory polygraph) who were prescribed continuous positive airway pressure treatment. Good adherence was defined as an average cumulative continuous positive airway pressure use of ≥ 4 hr per night at the end of the follow‐up. A multivariate Cox regression analysis was performed to identify independent predictors of continuous positive airway pressure adherence. Patients were followed for a median of 57.6 (42–72) months after initiating continuous positive airway pressure therapy. At the end of the follow‐up, the median continuous positive airway pressure use was 5.7 (inter‐quartile range 3.9–6.6) hr per night, and 132 patients (74.5%) showed good continuous positive airway pressure adherence. The only baseline variable associated with poor adherence was the presence of previous stroke (hazard ratio 4.00, 95% confidence interval 1.92–8.31). Adequate adherence at 1 month also predicted good adherence at the end of the follow‐up (hazard ratio 14.4, 95% confidence interval 4.94–56). Both variables also predicted adherence at a threshold of 6 hr per night. Our results show that good continuous positive airway pressure adherence is an achievable and feasible goal in patients with resistant hypertension and obstructive sleep apnea. Previous stroke and short‐term adherence predicted long‐term adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Good long‐term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea

Campos‐Rodríguez

Navarro-Soriano

Reyes-Núñez

et al. 2019

Journal of Sleep Research

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“…Patients referred for CPAP treatment want clear information about their condition (Broström et al., ). Early dropouts from CPAP treatment are common, as well as poor long‐term adherence (Baratta et al., ). Shared decision making is desirable because it generally is accepted as “a right”, and has, in other contexts, been shown to help patients to become adherent.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnea (OSA) (Epstein et al., ). Despite reduced symptoms and lowered risk of negative health consequences (Fu et al., ), adherence tends in many cases to be poor (Baratta et al., ). Early dropouts are frequent, and communication between patients and healthcare personnel (Broström, Fridlund, Hedberg, Nilsen, & Ulander, ) is important during the initiation of CPAP to prevent and intervene against side‐effects (Broström, Pakpour, Nilsen, Gardner, & Ulander, ; Ulander, Johansson, Ewaldh, Svanborg, & Broström, ).…”

Section: Introductionmentioning

confidence: 99%

Validation of CollaboRATE and SURE – two short questionnaires to measure shared decision making during CPAP initiation

Broström

Pakpour

Nilsén

et al. 2018

Journal of Sleep Research

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Adherence to continuous positive airway pressure (CPAP) treatment tends to be low. Brief validated instruments focusing on shared decision making have not been used in a CPAP context. The aim was to investigate factorial structure, categorical functioning of the response scale and differential item functioning across sub‐populations of the CollaboRATE and Sure questionnaires among patients with obstructive sleep apnea (OSA) before CPAP treatment is initiated. A prospective design, including 193 objectively diagnosed (polygraphy) OSA patients (68% men, 59.7 years, SD 11.5) from two CPAP clinics was used. Data were collected with the following questionnaires; Sure, CollaboRATE, Attitudes to CPAP Inventory, Epworth sleepiness scale, minimal insomnia symptoms scale, and hospital anxiety and depression scale. Objective CPAP use was collected after 6 months; 49% demonstrated decisional conflict on SURE and 51% scored low levels of shared decision making on CollaboRATE. Unidimensionality was found for both CollaboRATE (one factor explaining 57.4%) and SURE (one factor explaining 53.7%), as well as local independence. Differential item functioning showed both to be invariant across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. Latent class analyses showed that patients with low decisional conflict and high shared decision making were more adherent to CPAP treatment. CollaboRATE and SURE provided good validity and reliability scores to measure shared decision making and decisional conflict in relation to CPAP treatment. The questionnaires can be used by healthcare personnel as a tool to simplify the assessment of shared decision making.

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Demographics of Adults With Obstructive Sleep Apnea Who Undergo Nasal Surgery

Shah,

Darbinian,

Collazo

et al. 2024

OTO Open

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ObjectiveTo assess the demographic characteristics between adult obstructive sleep apnea (OSA) patients who did and did not undergo nasal surgery (NS).Study DesignRetrospective cohort study.SettingKaiser Permanente Northern California clinical database.MethodsRetrospective study of adult patients with ≥1 OSA diagnoses linked to clinical encounters from 2009 to 2016. Qualifying NS procedures performed on or after cohort entry through 2017 were ascertained. Demographic and clinical characteristics were compared; multivariable logistic regression examined associations of these characteristics with undergoing NS.ResultsA total of 174,821 patients had an OSA diagnosis. Among these, 3518 (2.0%) underwent NS, including septoplasty (61.9%), sinus‐related (12.9%), turbinate (14.2%), and rhinoplasty (11.1%) procedures. Compared to the nonsurgery group, NS patients were more likely to be male (75.5% vs 62.1%), younger (48.2 ± 13.0 vs 54.7 ± 14.1), have lower body mass index (31.8 ± 6.4 vs 34.3 ± 8.1), and no comorbid conditions (63.1% vs 53.5%), P < .001. After adjusting for sex, age, body mass index (BMI), neighborhood deprivation, and comorbidities, black and Asian/Pacific Islander adults with OSA had 42% and 46% decreased odds of undergoing NS compared with non‐Hispanic white patients (odds ratio, OR [95% confidence interval, CI]: 0.58 [0.50‐0.67] and 0.54 [0.49‐0.61]), while Hispanic patients had similar odds (OR [95% CI]: 1.02 [0.93‐1.12]). Patients living in neighborhoods of highest deprivation had 18% lower odds of undergoing NS, compared with patients from neighborhoods corresponding to areas of lowest deprivation (adjusted odds ratio [95% CI]: 0.82 [0.75‐0.91]).ConclusionThese findings suggest that younger age, male sex, lower BMI, and higher SES may be associated with a higher likelihood of undergoing NS in OSA patients.

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Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome

Cited by 71 publications

References 32 publications

Good long‐term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea

Good long‐term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea

Validation of CollaboRATE and SURE – two short questionnaires to measure shared decision making during CPAP initiation

Demographics of Adults With Obstructive Sleep Apnea Who Undergo Nasal Surgery

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