Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China; Queen Mary Hospital, School of Nursing, The University of Hong Kong, Hong Kong, SAR, China.
Queen Mary Hospital, School of Nursing, The University of Hong Kong, Hong Kong, SAR, China.
Chest. 2014 Sep;146(3):600-610. doi: 10.1378/chest.13-2228.
Poor adherence to CPAP treatment in OSA adversely affects the effectiveness of this therapy. This randomized controlled trial (RCT) examined the efficacy of a brief motivational enhancement education program in improving adherence to CPAP treatment in subjects with OSA.
Subjects with newly diagnosed OSA were recruited into this RCT. The control group received usual advice on the importance of CPAP therapy and its care. The intervention group received usual care plus a brief motivational enhancement education program directed at enhancing the subjects' knowledge, motivation, and self-efficacy to use CPAP through the use of a 25-min video, a 20-min patient-centered interview, and a 10-min telephone follow-up. Self-reported daytime sleepiness adherence-related cognitions and quality of life were assessed at 1 month and 3 months. CPAP usage data were downloaded at the completion of this 3-month study.
One hundred subjects with OSA (mean ± SD, age 52 ± 10 years; Epworth Sleepiness Scales [ESS], 9 ± 5; median [interquartile range] apnea-hypopnea index, 29 [20, 53] events/h) prescribed CPAP treatment were recruited. The intervention group had better CPAP use (higher daily CPAP usage by 2 h/d [Cohen d = 1.33, P < .001], a fourfold increase in the number using CPAP for ≥ 70% of days with ≥ 4 h/d [P < .001]), and greater improvements in daytime sleepiness (ESS) by 2.2 units (P = .001) and treatment self-efficacy by 0.2 units (P = .012) compared with the control group.
Subjects with OSA who received motivational enhancement education in addition to usual care were more likely to show better adherence to CPAP treatment, with greater improvements in treatment self-efficacy and daytime sleepiness.
ClinicalTrials.gov; No.: NCT01173406; URL: www.clinicaltrials.gov.
阻塞性睡眠呼吸暂停（OSA）患者对 CPAP 治疗的依从性差会对治疗效果产生不利影响。本随机对照试验（RCT）旨在检验简短动机增强教育方案在改善 OSA 患者 CPAP 治疗依从性方面的疗效。
本 RCT 纳入了新诊断为 OSA 的患者。对照组接受 CPAP 治疗重要性及其护理的常规建议。干预组接受常规护理，外加简短动机增强教育方案，该方案通过 25 分钟的视频、20 分钟的以患者为中心的访谈和 10 分钟的电话随访，增强患者对 CPAP 治疗的知识、动机和自我效能，从而提高其 CPAP 治疗的依从性。在 1 个月和 3 个月时评估日间嗜睡、与依从性相关的认知和生活质量。在这项 3 个月的研究结束时下载 CPAP 使用数据。
共纳入 100 例 OSA 患者（平均年龄±标准差为 52±10 岁；Epworth 睡眠量表[ESS]评分为 9±5；中位[四分位数间距]呼吸暂停低通气指数为 29[20，53]次/小时），这些患者均接受 CPAP 治疗。干预组的 CPAP 使用情况更好（每日 CPAP 使用时间增加 2 小时/d[Cohen d = 1.33，P <.001]，每日使用 CPAP 且≥4 小时/d 的天数比例增加 4 倍[P <.001]），日间嗜睡（ESS）评分降低 2.2 分（P =.001），治疗自我效能感提高 0.2 分（P =.012），与对照组相比均有显著改善。
在常规护理的基础上接受动机增强教育的 OSA 患者更有可能提高 CPAP 治疗的依从性，治疗自我效能感和日间嗜睡均有显著改善。
ClinicalTrials.gov；编号：NCT01173406；网址：www.clinicaltrials.gov。
