Using Feedback from Naturalistic Driving to Improve Treatment Adherence in Drivers with Obstructive Sleep Apnea

Untreated obstructive sleep apnea (OSA) has numerous negative health-related consequences. Continuous positive airway pressure (CPAP) is generally considered the treatment of choice for OSA, but rates of nonadherence are high. It is believed that OSA is more prevalent among men; therefore understanding how OSA presents among women is limited and treatment adherence has received little research attention. For this study, 29 women were recruited from primary care offices. They completed a questionnaire battery and underwent a night of nocturnal polysomnography (PSG) followed by a visit with a sleep specialist. Women diagnosed with OSA were prescribed CPAP; 2 years later CPAP adherence was evaluated. Results show that approximately half the sample was adherent. There were no significant differences between adherent and nonadherent women on OSA severity; however CPAP adherent women had worse nocturnal and daytime functioning scores at the time of diagnosis. Moreover, when the seven nocturnal and daytime variables were used as predictors in a discriminant analysis, they could predict 87% of adherent and 93% of the nonadherent women. The single most important predictor was nonrefreshing sleep. We discuss the implications of the findings for identifying women in primary care with potential OSA and offer suggestions for enhancing treatment adherence.

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Impact of the Novel Coronavirus Disease (COVID-19) on Treatment Adherence and Sleep Duration in Obstructive Sleep Apnea Patients Treated with Positive Airway Pressure

10.1101/2020.06.28.20141994 ◽

2020 ◽

Cited By ~ 1

Author(s):

Salma Batool-Anwar ◽

Olabimpe S. Omobomi ◽

Stuart F. Quan

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Adherence ◽

Sleep Duration ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Obstructive Sleep ◽

Number Of Patients ◽

Significant Difference ◽

Adherence Data

AbstractObjectiveTo examine the effect of COVID-19 on treatment adherence and self-reported sleep duration among patients with Obstructive Sleep Apnea (OSA) treated with positive airway pressure (PAP) therapy.MethodsRetrospective review of medical records of patients seen in Sleep and Circadian Clinic at Brigham Health during the immediate period of one month after the national lockdown was announced on March 15, 2020. Patients with OSA were included only if PAP adherence data was available in the 12-months prior and in the month after the lockdown. Patients with other sleep disorders and OSA patients without the adherence data were excluded.ResultsMean age was 63.5± 13.9 years, 55% of the participants were men, and mean BMI was 31.8 ± 7.9 kg/m2. Severe OSA was noted among 59.5% compared to 29.3% moderate, and 11.2% mild OSA. Increased number of patients reported insomnia after the lockdown (41% vs 48%, p= 0.02). Gender stratification noted worsening insomnia only among women. There was no significant difference in PAP adherence as measured by the hours of use, self-reported sleep duration or in the use of sleep medications.ConclusionPost COVID-19 lockdown had a negative impact on sleep as evidenced by increased reporting of insomnia particularly among women, but no impact on PAP adherence or self-reported sleep duration.

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Positive Airway Pressure Treatment Adherence in Adults with Obstructive Sleep Apnea: A Perspective on the Ever-evolving State of Science

Chonnam Research Institute of Nursing Science ◽

10.33527/nhi2019.24.2.75 ◽

2019 ◽

Vol 24 (2) ◽

pp. 75-88

Author(s):

Amy M. Sawyer

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Adherence ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Pressure Treatment ◽

Obstructive Sleep

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Impact of the novel coronavirus disease on treatment adherence and sleep duration in patients with obstructive sleep apnea treated with positive airway pressure

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.8746 ◽

2020 ◽

Vol 16 (11) ◽

pp. 1917-1920 ◽

Cited By ~ 1

Author(s):

Salma Batool-Anwar ◽

Olabimpe S. Omobomi ◽

Stuart F. Quan

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Adherence ◽

Sleep Duration ◽

Airway Pressure ◽

Positive Airway Pressure ◽

The Novel ◽

Obstructive Sleep ◽

Novel Coronavirus

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Treatment adherence should be taken into account when reporting treatment outcomes in obstructive sleep apnea

The Laryngoscope ◽

10.1002/lary.24302 ◽

2013 ◽

Vol 124 (1) ◽

pp. 344-345 ◽

Cited By ~ 22

Author(s):

Madeline J. L. Ravesloot ◽

Nico Vries ◽

Boris A. Stuck

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Outcomes ◽

Treatment Adherence ◽

Obstructive Sleep

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Hypoglossal Nerve Stimulation in Veterans With Comorbid Insomnia and Sleep Apnea

Otolaryngology ◽

10.1177/0194599820982638 ◽

2021 ◽

pp. 019459982098263

Author(s):

Reena Dhanda Patil ◽

Michael P. Hong ◽

Stacey L. Ishman

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Adherence ◽

Hypoglossal Nerve ◽

Case Series ◽

Comorbid Insomnia ◽

Obstructive Sleep ◽

Significant Difference ◽

Clinical Records ◽

Clinical Measures

Objective Insomnia and sleep apnea frequently co-occur, with additive effects of both disorders presenting clinicians with unique treatment challenges compared to one disorder alone. The hypoglossal nerve stimulator (HNS) is a promising treatment for patients with comorbid insomnia and sleep apnea (COMISA), many of whom have positive airway pressure (PAP) intolerance. Our aim was to determine adherence to and efficacy of HNS in veterans with COMISA refractory to PAP therapy compared to those with obstructive sleep apnea alone (OSA only). Study Design Retrospective case series. Setting A single, academic Veterans Affairs medical center. Methods Review of clinical records, pre- and postoperative polysomnography, and clinical measures of obstructive sleep apnea (OSA), sleepiness, and insomnia was conducted in 53 consecutive cases of veterans with OSA undergoing HNS implantation. HNS adherence was obtained at postoperative visits. HNS adherence and efficacy were compared between individuals with COMISA and OSA only. Results COMISA was noted in 30 of 53 (56.6%) veterans studied. There was no significant difference between HNS adherence in patients with COMISA and OSA only (5.6 vs 6.4 h/night, P = .17). HNS implantation improved polysomnographic and clinical measures of OSA and sleepiness in both COMISA and OSA only, and 56.5% (13/23) of patients with COMISA self-reported improvement in insomnia after surgery. Conclusion HNS was successful in treating a complex veteran population with COMISA refractory to PAP when examining measures of treatment adherence and efficacy. Future studies of patients with COMISA undergoing HNS will examine effective combination therapy targeting insomnia and a multidisciplinary effort to optimize treatment adherence.

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Adequate health literacy is associated with adherence to continuous positive airway pressure in adults with obstructive sleep apnea

SLEEP Advances ◽

10.1093/sleepadvances/zpab013 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Claire M Ellender ◽

Sebastian Le Feuvre ◽

Mary Boyde ◽

Brett Duce ◽

Sara Winter ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Health Literacy ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Treatment Adherence ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Adequate Health Literacy ◽

Obstructive Sleep ◽

Inadequate Health Literacy

Abstract Study Objectives Obstructive sleep apnea (OSA) is a chronic disease with significant health implications and adequate adherence to continuous positive airway pressure (CPAP) is essential for effective treatment. In many chronic diseases, health literacy has been found to predict treatment adherence and outcomes. In this study, the aim was to determine the health literacy of a sleep clinic population and evaluate the association between health literacy and CPAP adherence. Methods A prospective cohort study was undertaken, recruiting 104 consecutive patients with a variety of sleep diagnoses. The Short Form Rapid Estimate of Adult Literacy in Medicine (REALM-SF), a validated questionnaire, was administered to measure health literacy. In a sub-group of 91 patients prescribed CPAP for OSA, CPAP usage was measured, with adequate usage defined as greater than 4 h/night CPAP therapy. Results Seventy-one percent of the sleep clinic cohort was found to have adequate health literacy, as measured by the REALM-SF. In those prescribed CPAP for OSA, inadequate health literacy was associated with a twofold increased risk for inadequate CPAP usage (adjusted odds ratio [OR] 2.9, 95% CI: 1.1 to 8.22, p = 0.045). There was a 1.7 h/night difference in median CPAP usage comparing those with adequate to inadequate health literacy (4.6 h vs. 6.3 h/night). Conclusions The majority of this sleep disorders cohort had adequate health literacy as measured by the REALM-SF questionnaire. However, inadequate health literacy appears to be an independent predictor of treatment adherence and may represent a modifiable risk factor of poor treatment outcomes in OSA.

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Effectiveness of Electronic Health Interventions in Improving Treatment Adherence for Adults With Obstructive Sleep Apnea: Meta-Analytic Review

Journal of Medical Internet Research ◽

10.2196/16972 ◽

2020 ◽

Vol 22 (2) ◽

pp. e16972 ◽

Cited By ~ 3

Author(s):

Jiska Joëlle Aardoom ◽

Lisa Loheide-Niesmann ◽

Hans C Ossebaard ◽

Heleen Riper

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Treatment Adherence ◽

Meta Analysis ◽

Risk Of Bias ◽

Cpap Adherence ◽

Cpap Treatment ◽

Obstructive Sleep ◽

Analytic Review ◽

Electronic Health

Background Poor adherence to continuous positive airway pressure (CPAP) treatment by adults with obstructive sleep apnea (OSA) is a common issue. Strategies delivered by means of information and communication technologies (ie, electronic health [eHealth]) can address treatment adherence through patient education, real-time monitoring of apnea symptoms and CPAP adherence in daily life, self-management, and early identification and subsequent intervention when device or treatment problems arise. However, the effectiveness of available eHealth technologies in improving CPAP adherence has not yet been systematically studied. Objective This meta-analytic review was designed to investigate the effectiveness of a broad range of eHealth interventions in improving CPAP treatment adherence. Methods We conducted a systematic literature search of the databases of Cochrane Library, PsycINFO, PubMed, and Embase to identify relevant randomized controlled trials in adult OSA populations. The risk of bias in included studies was examined using seven items of the Cochrane Collaboration risk-of-bias tool. The meta-analysis was conducted with comprehensive meta-analysis software that computed differences in mean postintervention adherence (MD), which was defined as the average number of nightly hours of CPAP use. Results The meta-analysis ultimately included 18 studies (N=5429 adults with OSA) comprising 22 comparisons between experimental and control conditions. Postintervention data were assessed at 1 to 6 months after baseline, depending on the length of the experimental intervention. eHealth interventions increased the average nightly use of CPAP in hours as compared with care as usual (MD=0.54, 95% CI 0.29-0.79). Subgroup analyses did not reveal significant differences in effects between studies that used eHealth as an add-on or as a replacement to care as usual (P=.95), between studies that assessed stand-alone eHealth and blended strategies combining eHealth with face-to-face care (P=.23), or between studies of fully automated interventions and guided eHealth interventions (P=.83). Evidence for the long-term follow-up effectiveness of eHealth adherence interventions remains undecided owing to a scarcity of available studies and their mixed results. Conclusions eHealth interventions for adults with OSA can improve adherence to CPAP in the initial months after the start of treatment, increasing the mean nightly duration of use by about half an hour. Uncertainty still exists regarding the timing, duration, intensity, and specific types of eHealth interventions that could be most effectively implemented by health care providers.

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