Relationships and CPAP adherence among women with obstructive sleep apnea

Abstract

Background: Obstructive sleep apnea contributes to daytime sleepiness, poor quality of life and increased risk for heart disease and hypertension among women. Continuous positive airway pressure improves sleepiness and quality of life and may reduce health risks but few studies have evaluated predictors of adherence among women. The goal of this study was to evaluate the role of relationship factors in women's continuous positive airway pressure (CPAP) adherence and change in relationship quality among married/partnered women. Methods: Women recently diagnosed with obstructive sleep apnea completed relationship quality, social support questionnaires and spousal involvement interviews. CPAP adherence was collected at 12 weeks. Results: Data were available for 16 women. Average CPAP adherence was 3.6 SD = 2.7 h per night. Women with higher reports of social support had higher adherence. None of the unmarried/partnered participants were adherent to the recommendation of CPAP use ≥ 4 h per night at 12 week follow-up. Marital status was not associated with demographic, disease severity or social support measures. Relationship conflict among married/partnered participants was associated with lower adherence. In qualitative surveys, encouragement and support were the two most commonly reported types of partner involvement. Relationship quality did not change between baseline and 3 months. Conclusion: Results suggest relationship factors are robust predictors of CPAP adherence among women with obstructive sleep apnea.

The Persistent Gender Bias in the Diagnosis of Obstructive Sleep Apnea

“…Adherence has been defined differently in different studies; limited data in women suggests it is lower but results have been contradictory. 45 In one study, women were 1.72 times more likely to be nonadherent to CPAP therapy compared to men, even after adjusting to race, marital status, and age; in another study women showed less hours of use. 46,47 Fourteen months of data from the sleep center in Helsinki University Hospital showed that women were 1.2 times more likely to switch masks than men even after initial individualized mask fitting and that patients who switched masks had 7 times higher risk for stopping CPAP therapy within 1 year.…”

“…39 Other factors such as being married or living with a partner, greater perceived social support, and higher relationship quality (less conflict) have been predictive of higher adherence in women. 45 Treatment options have been traditionally developed and tested in men including interfaces and auto-titrating CPAP machine algorithms. New algorithms with longer ramps, aiming at being more responsive to flow limitation and better at treating REM events have been recently developed.…”

“…39 Other factors such as being married or living with a partner, greater perceived social support, and higher relationship quality (less conflict) have been predictive of higher adherence in women. 45…”

Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults

“…Some individuals struggle using their PAP machine, which they believe identifies them as ill, odd or not able to take care of themselves [50][51][52][53] or they experience side effects, which have repeatedly been voiced as a barrier to continued PAP use 50,51,[54][55][56][57] . Social support can help many patients increase their PAP use and includes spousal support 50,51,[54][55][56]58,59 . However, not all spousal input is the same and partners who are too invasive can negatively impact on PAP use 58 .…”

“…Social support can help many patients increase their PAP use and includes spousal support 50,51,[54][55][56]58,59 . However, not all spousal input is the same and partners who are too invasive can negatively impact on PAP use 58 . Regular PAP users find themselves having to utilise internal means, such as willpower, positive attitudes and self-efficacy 54,55,60 , and engage in a cost-benefit evaluation 55,59 .…”