Polysomnograph Chart View by Patients: A New Educational Strategy to Improve CPAP Adherence in Sleep Apnea Therapy

Abstract

BACKGROUND: CPAP is currently the treatment of choice for obstructive sleep apnea syndrome, but therapy adherence is poor. Many educational trials have been proposed to increase CPAP adherence. We tested the hypothesis that polysomnograph chart viewing by patients would improve CPAP adherence. METHODS: A controlled parallel group study was performed with 206 newly diagnosed obstructive sleep apnea syndrome patients, randomized into 2 groups (n ‫؍‬ 103 each): standard support group, and educational support group. Each educational support group subject viewed 2 consecutive polysomnograms on the computer screen: the first recorded during a standard diagnostic overnight polysomnography, and the second during a full-night polysomnography with nasal CPAP. The subject's attention was drawn only to the flow and oxyhemoglobin saturation curves. Clinical outcomes were assessed via polysomnography at CPAP initiation and after 1, 3, and 12 months. RESULTS: After 12 months of CPAP, 76% of the educational support group and 52% of the standard support group returned for a follow-up visit (P < .001). Statistical significance had already been reached after 1 and 3 months. Moreover, CPAP use (measured as hours of use per night) was higher in the educational support group at each control visit. CONCLUSIONS: Polysomnograph chart viewing by obstructive sleep apnea patients can increase CPAP adherence, as evaluated by rate of return for the follow-up visit and mean nightly CPAP use.

Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

“…There are only limited data from long-term randomised clinical trials evaluating an intensive follow-up programme aimed at improving CPAP compliance [47][48][49][50][51][52]. Three studies found no significant difference between intensive and standard care alone regarding compliance with CPAP treatment or quality of life [47,49,52].…”

“…Three studies found no significant difference between intensive and standard care alone regarding compliance with CPAP treatment or quality of life [47,49,52]. In a study by FALCONE et al [48] in which 206 patients were randomised into two groups, patients in the educational support group, who had the opportunity to review their own PSG charts before and after CPAP, showed better adherence after 12 months of therapy. Another randomised clinical trial showed enhanced CPAP use in a small sample of participants who received a 12-month telemedicine intervention [50].…”

User Compliance and Behavioral Adaptation Associated With Supine Avoidance Therapy

“…It's unclear if this is due to a lack of interest, lack of education pertaining to the benefit of using the report, lack of positive reinforcement by the clinician, or difficulty using the Webbased software. Research is needed to determine if patient access to treatment outcomes has a similar positive impact on utilization as patient access to diagnostic information (Falcone, Damiani, Quaranta, Capozzolo, & Resta, 2014).…”

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

“…Polysomnography was conducted and scored using standard American Academy of Sleep Medicine guidelines 47 as well as standard rules for calculating the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI). 47,48 Similar to models recently described in RESPIRATORY CARE, 49,50 we also engage patients to view select polysomnographic tracings of their sleep studies to enhance their education (the supplementary materials at http://www.rcjournal.com describe additional scoring details and our titration practice model, including use of ABPAP and ASV PAP devices to increase patient comfort and compliance).…”