Aloia Mark S, Arnedt J Todd, Stepnowsky Carl, Hecht Jackie, Borrelli Belinda
Department of Psychiatry and Human Behavior Brown Medical School, Providence, RI, USA.
J Clin Sleep Med. 2005 Oct 15;1(4):346-53.
To determine the relative predictive utility of measures of behavior-change principles on treatment adherence in individuals with obstructive sleep apnea.
Ninety-eight participants with moderate to severe obstructive sleep apnea were recruited into this prospective longitudinal study. Participants were recruited from an academic sleep disorders center after having completed in-lab polysomnography and before initiating continuous positive airway pressure (CPAP) therapy. Participants were all treatment naive. Measurements of behavior-change principles were taken at baseline and periodically throughout the 6-month follow-up. Adherence, measured by the amount of nightly use at the proper pressure, was monitored covertly by the CPAP machines.
Measures from 2 behavior-change theories (Transtheoretical Model and Social Cognitive Theory) were used in this study: readiness to change, perceived self-efficacy, and decisional balance. The results from the present study suggest that measures of behavior change predict CPAP adherence at 6 months posttreatment when assessed at 1 week and at 3 months posttreatment. When these measures are assessed at baseline, however, they are not predictive of CPAP use at 6-months. These measures do not improve upon the prediction of 6-month adherence provided by previous adherence.
While the readiness, decisional balance, and self-efficacy measures were all predictive of adherence, the strongest predictive utility came from measures of readiness and self-efficacy. Those individuals who use CPAP more were more likely to rate themselves as ready and confident in their ability to use CPAP. The utility of these measures was diminished when controlling for previous use. Our intention, however, was to study modifiable risk factors for poor adherence. Principles of behavior change, which are often used in adherence research in other medical populations, are thought to be modifiable with behavioral interventions and show promise for improving adherence.
确定行为改变原则的测量指标对阻塞性睡眠呼吸暂停患者治疗依从性的相对预测效用。
98名中重度阻塞性睡眠呼吸暂停患者被纳入这项前瞻性纵向研究。参与者在完成实验室多导睡眠图检查后、开始持续气道正压通气（CPAP）治疗前，从一个学术性睡眠障碍中心招募而来。所有参与者此前均未接受过治疗。在基线时以及整个6个月随访期间定期对行为改变原则进行测量。通过CPAP机器暗中监测以适当压力每晚使用的时长来衡量的依从性。
本研究使用了两种行为改变理论（跨理论模型和社会认知理论）的测量指标：改变的准备度、自我效能感和决策平衡。本研究结果表明，在治疗后1周和3个月进行评估时，行为改变的测量指标可预测治疗后6个月的CPAP依从性。然而，当在基线时评估这些指标时，它们并不能预测6个月时的CPAP使用情况。这些指标并不能比先前的依从性更好地预测6个月时的依从性。
虽然改变的准备度、决策平衡和自我效能感指标均能预测依从性，但最强的预测效用来自改变的准备度和自我效能感指标。那些更多使用CPAP的个体更有可能认为自己已做好准备且有能力使用CPAP。在控制先前使用情况后，这些指标的效用有所降低。然而，我们的目的是研究依从性差的可改变风险因素。行为改变原则常用于其他医学人群的依从性研究中，被认为可通过行为干预进行改变，并有望提高依从性。
