Department of Medicine, Michigan State University, East Lansing, Michigan.
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan.
J Clin Sleep Med. 2022 Jan 1;18(1):181-191. doi: 10.5664/jcsm.9534.
The aim of the Improving CPAP Adherence Program was to assess the impact of a multidimensional treatment framework based on shared decision-making, patient activation, and caregiver engagement on improving long-term positive airway pressure (PAP) adherence in patients newly diagnosed with obstructive sleep apnea.
In this pilot study, patients aged ≥ 18 years with a new obstructive sleep apnea diagnosis who qualified for PAP treatment and lived with a caregiver were randomly assigned to receive either the multidimensional treatment (intervention, n = 28) or unrelated education (control group, n = 32). All patients and their caregiver participated in a group visit. The intervention group attended 4 structured sessions: interactive education, peer coaching, hands-on experience, and a semistructured motivational interview. The control group was educated on physical activity and lifestyle only. Objective PAP adherence data were obtained at baseline (day that they received PAP machine to group visit), group visit to 3 months, and 3-6 months.
In an age-adjusted model, the mean daily use of PAP increased significantly over the 3 time periods ( = .03). Intervention-arm participants gained a mean 1.23 hours (95% confidence interval, 0.33-2.13) in PAP mean daily use between 3 and 6 months vs those in the control arm ( = .008). We saw no difference in the percentage of PAP adherence across time between the 2 arms.
A multifaceted patient-centered intervention with caregiver engagement improved PAP adherence vs control levels, a beneficial effect sustained for the 6 months. Our findings suggest that caregivers, with the appropriate training, can improve patients' PAP adherence by providing a socially supportive environment.
Khan NNS, Todem D, Bottu S, Badr MS, Olomu A. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. 2022;18(1):181-191.
改善 CPAP 依从性计划的目的是评估基于共同决策、患者激活和照顾者参与的多维治疗框架对改善新诊断为阻塞性睡眠呼吸暂停患者的长期正压通气（PAP）依从性的影响。
在这项试点研究中，符合 PAP 治疗条件且与照顾者同住的年龄≥18 岁的新诊断为阻塞性睡眠呼吸暂停的患者被随机分为接受多维治疗（干预组，n=28）或不相关教育（对照组，n=32）。所有患者及其照顾者均参加了小组访问。干预组参加了 4 次结构化会议：互动教育、同伴辅导、实践经验和半结构化动机访谈。对照组仅接受有关体育活动和生活方式的教育。在基线（他们接受 PAP 机到小组访问的那一天）、小组访问到 3 个月和 3-6 个月时，获得了客观的 PAP 依从性数据。
在年龄调整模型中，在 3 个时间段内，PAP 的平均每日使用量显著增加（=.03）。与对照组相比，干预组在 3 至 6 个月期间，PAP 平均每日使用量增加了 1.23 小时（95%置信区间，0.33-2.13）（=.008）。我们没有看到 2 个组之间的 PAP 依从性百分比随时间的差异。
多方面的以患者为中心的干预措施和照顾者的参与提高了 PAP 依从性，与对照组相比，这一有益效果持续了 6 个月。我们的研究结果表明，经过适当培训的照顾者可以通过提供社会支持环境来提高患者的 PAP 依从性。
Khan NNS，Todem D，Bottu S，Badr MS，Olomu A。在改善阻塞性睡眠呼吸暂停患者持续气道正压通气依从性中患者和家庭参与的影响：一项随机对照试验。2022；18（1）：181-191。
