The effect of positive and negative message framing on short term continuous positive airway pressure compliance in patients with obstructive sleep apnea

Pengo, Martino F.; Czaban, Marcin; Berry, Marc; Nirmalan, Prajeshan; Brown, Richard S.; Birdseye, Adam; Woroszyl, Asia; Chapman, Jennifer; Kent, Brian D.; Hart, Nicholas; Rossi, Gian Paolo; Steier, Joerg

doi:10.21037/jtd.2017.07.110

Cited by 29 publications

(40 citation statements)

References 42 publications

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“…Long‐term treatment adherence for CPAP therapy can be limited despite the use of improved technology and behavioural interventions . The use of lower expiratory pressures may improve comfort and reduce mask leak.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term treatment adherence for CPAP therapy can be limited despite the use of improved technology and behavioural interventions. 20 The use of lower expiratory pressures may improve comfort 30 and reduce mask leak. Tailoring ventilator settings by titrating IPAP, EPAP, adjusting flow triggers, Ti and mandatory backup breaths, as well as selecting the ventilator mode (volume/pressure-support/control) can replicate a physiological breathing pattern that reduces the inspiratory effort and positively impacts respiratory muscle unloading.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of previously published data from our sleep centre on CPAP compliance and adherence, the provided parameters were of a significance level (adjusted for sidedness) of 0.025, SD within patients of 2.4 h/day. The power expected was 0.85 and the expected minimal clinical important difference in the means of nightly adherence between the different treatment modalities was 1.5 h. A total of 48 patients needed to enter this two‐treatment crossover study to achieve a probability of 85% that the study would detect a difference at a two‐sided 0.05 significance level, if the true difference between treatments was at least 1.5 h/night.…”

Section: Methodsmentioning

confidence: 99%

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BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

et al. 2019

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Background and objective Continuous positive airway pressure (CPAP) is the most common treatment for obstructive sleep apnoea (OSA), but many patients fail long‐term therapy. Bilevel positive airway pressure (BPAP) is a potential alternative. We hypothesized that BPAP could improve treatment adherence and outcomes in patients who cannot tolerate CPAP. Methods Patients with OSA who failed CPAP (usage < 4 h/day) and were referred to a tertiary sleep centre between 2014 and 2017 for BPAP were included. Age, gender, body mass index (BMI), co‐morbidities, CPAP use and reasons for failure, Epworth Sleepiness Scale (ESS), sleep study data, spirometry data and average maximum nightly compliance were recorded. Results A total of 52 patients with OSA requiring CPAP > 15 cm H2O (71% male, age: 58 (15) years, BMI: 42.6 (10.1) kg/m2, apnoea–hypopnoea index (AHI): 51.1 (30.4)/h) were studied; 62% had respiratory co‐morbidities affecting nocturnal breathing including obesity hypoventilation syndrome and COPD; 25% had neuromuscular conditions; and 17% had cardiovascular disease. CPAP was used for 199 (106–477) days prior to referral for BPAP. Reasons for CPAP failure were intolerant pressures (23%), uncontrolled symptoms (23%), mask problems (21%), adverse effects (13%), claustrophobia (8%), co‐morbidities (8%) and other issues (4%). Lower expiratory positive airway pressures were needed with BPAP compared to CPAP (10 (8–12) vs 16.8 (15.7–19.2) cm H2O, P = 0.001); patients achieved better adherence to BPAP (7.0 (4.0–8.5) vs 2.5 (1.6–6.7) h/night, P = 0.028) and better symptom control (ESS: 4.0 (1.0–7.0) vs 10.0 (6.0–17.0) points, P = 0.039). Conclusion In patients with moderate–severe OSA who fail CPAP therapy due to low adherence, BPAP is well tolerated and achieves sufficient control of sleep‐disordered breathing and its symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

et al. 2019

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“…Greater success has been described with cognitive behavioural or motivational strategies in improving adherence . These behavioural strategies again recognize the psychosocial influences on PAP adherence.…”

Section: Augmenting Adherencementioning

confidence: 99%

“…Greater success has been described with cognitive behavioural or motivational strategies in improving adherence. 35,[45][46][47][48][49][50][51] These behavioural strategies again recognize the psychosocial influences on PAP adherence. In a meta-analysis assessing the effectiveness of educational, supportive or behavioural strategies in encouraging CPAP use, most studies incorporated elements of more than one intervention.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Strategies to augment adherence in the management of sleep‐disordered breathing

Sunwoo

Malhotra

2019

Respirology

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Continuous positive airway pressure (CPAP) is highly effective in treating sleep‐disordered breathing (SDB). However, unlike surgical interventions, this treatment modality relies heavily on patient acceptance and adherence. The current definition of adherence is largely arbitrary and is mainly used by third‐party payers to determine CPAP reimbursement but CPAP adherence remains sub‐optimal. Strategies to augment adherence, especially early in the course of a CPAP trial, are needed in the management of SDB. An understanding of the basis for observed differences in CPAP and oral appliance (OA) use is necessary in developing these strategies, but to date no single factor has been consistently identified. Consequently, a multidimensional approach using educational, behavioural, technological and potentially pharmacological strategies to target (i) disease characteristics, (ii) patient characteristics including psychosocial factors, (iii) treatment protocols and (iv) technological devices and side effects that may influence adherence, is likely required to augment the complex behaviour of CPAP and OA use. In the near future, we envision a personalized medicine approach to determine the risk of non‐adherence and set individualized adherence goals aimed at treating specific symptoms (e.g. excessive daytime sleepiness) and reducing the risk of patient‐specific SDB consequences (e.g. atherosclerosis). Resources for interventions to improve adherence such as educational programmes and telemedicine encounters could then be more efficiently allocated.

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Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea

Askland

Wright

Woźniak

et al. 2020

Cochrane Database of Systematic Reviews

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The effect of positive and negative message framing on short term continuous positive airway pressure compliance in patients with obstructive sleep apnea

Abstract: Positively framed messages can improve CPAP adherence in patients with OSA in the short-term; however, strategies for implementing its long-term use need to be developed.

Cited by 29 publications

References 42 publications

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study

Strategies to augment adherence in the management of sleep‐disordered breathing

Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea

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