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Title Intensive Patient Education And Social Support Significantly Improves CPAP Therapy Adherence In Obstructive Sleep Apnea (OSA) Patients
Clinical Question For obstructive sleep apnea patients treated with CPAP, will focused therapy education and social support result in improved CPAP adherence?
Clinical Bottom Line Intensive patient education and support improves CPAP therapy adherence in OSA patients. According to the literature, patient compliance is a major limitation of CPAP treatment; decreased adherence diminishes the effectiveness of therapy. Comprehensive interventions that include social support and focused education to promote patient adherence are critical to augment CPAP use and improve OSA symptoms. This is supported by a systematic review by Sawyer et. al. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21652236Sawyer/2011All age groupsSystematic Review
Key resultsOne of the reviewed studies included an intervention that combined self-efficacy promotion, education and support (including home visits by nurses) vs. standard support. Significant differences in adherence were noted between the intensive vs. standard support groups at 6 months (5.4 ± 0.3 hrs/night vs. 3.8 ± 0.4 hrs/night, respectively, p= 0.003).
#2) 19129293Damjanovic/2009100 Adults (57 +/- 12 y/o) RCT
Key resultsIntensive support (standard support plus additional interviews at 1,2,4,5,and 6 months after CPAP treatment, equipment optimization, education and counseling), as compared to standard support(CPAP monitoring, plus interviews at 3 and 9 months post-CPAP treatment), improved patient CPAP adherence significantly: hour/day use rate [5.7 +/- 0.2 vs. 4.6 +/- 0.4 (p<.05)], percent of days used [80.4 +/- 2.8 vs. 57 +/- 5.9 (p< .001)], individual sleep time proportion [80.6 +/- 3.2 vs. 64.2 +/- 6.2 (p<.05)].
#3) 19786730Fuchs/2010475 Adults: 232 controls (59.7 +/- 9.5 y/o) and 243 intervention (59.3 +/- 9.8 y/o) Controlled CT
Key resultsOSA patients in the intervention group (information booklet/education on CPAP use) presented higher hour/day use rate (6.9 +/- 0.9) vs. control patients (5.7 +/- 1.3), p<.001
Evidence Search (Obstructive sleep apnea AND cpap) AND cpap compliance AND ((Randomized Controlled Trial[ptyp] OR Meta-Analysis[ptyp] OR Review[ptyp] OR systematic[sb] OR Clinical Trial[ptyp]) AND "2008/02/09"[PDat] : "2013/02/06"[PDat] AND English[lang] AND ("adult"[MeSH Terms] OR "adult"[MeSH Terms:noexp] OR "aged"[MeSH Terms]))
Comments on
The Evidence
Validity: Sawyer et. al. published a comprehensive systematic review to summarize the current evidence on CPAP adherence and promotion interventions. Damjanovic et. al.’s controlled trial had a sample size of 100 randomized into 4 groups of 25. They also looked at effects of auto-adjusting CPAP compared to standard device with and without support intervention, followed up at 3 and 9 months after therapy initiation. The controlled trial by Fuchs et. al. had limitations, including not randomizing their subjects, not accounting for different CPAP models used by the study population, and relying on self-reported device use.
Applicability For obstructive sleep apnea (OSA) patients, intensive education, information on CPAP use, and social support (including spouses and close relatives) are highly recommended as they have been shown to improve patient adherence to CPAP therapy, therefore enhancing the effectiveness of treatment.
Specialty/Discipline (Public Health) (General Dentistry) (Prosthodontics) (Dental Hygiene) (Behavioral Science)
Keywords Obstructive Sleep Apnea, CPAP, CPAP compliance
ID# 2340
Date of submission: 02/14/2013spacer
E-mail solivanortiz@uthscsa.edu
Author Aida M. Solivan-Ortiz
Co-author(s) Brian K. Hill
Co-author(s) e-mail Hillbk@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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Comments and Evidence-Based Updates on the CAT
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by Hanna Lindskog (San Antonio, TX) on 05/19/2013
Similar findings exist related to OSA in children. DiFeo published a study in 2012 PMID: 22701385 showing a positive correlation between maternal education and CPAP adherence as well as family social support and CPAP adherence. A study by Uyar in 2012, PMID 22554366 indicates patient and bed partner's satisfaction about the device yielded higher compliance rates. This finding is consistent with my experience in my personal life as well as clinical practice.

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