The Thailand Centre for Evidence-Based Health Care, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
The Thailand Centre for Evidence-Based Health Care, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
Appl Nurs Res. 2023 Feb;69:151654. doi: 10.1016/j.apnr.2022.151654. Epub 2022 Dec 14.
Continuous positive airway pressure (CPAP) therapy is the treatment of choice for Obstructive Sleep Apnea (OSA) syndrome; however, interventions to improve CPAP adherence are still inconclusive.
This study aimed to examine the effectiveness of behavioral and psychosocial interventions on CPAP adherence.
The PRISMA guidelines and JBI approach for Systematic Review and Meta-analysis were used. Participants included 1) newly diagnosed patients with OSA, naive to CPAP treatment; 2) any type of behavioral and/or psychosocial intervention delivered via individual or group level; 3) CPAP adherence as an outcome. Two reviewers independently selected studies, evaluated their methodological quality, and extracted data.
Critical appraisal was conducted on 34 of the 1657 studies, with 18 RCTs included in the final review. Telemonitoring increased the mean nightly hour of CPAP use compared to standard care (WMD = 0.76, 95 % CI = 0.31-1.20, p = 0.001, I = 0 %, moderate certainty of evidence). Positive results were discovered in Motivational Enhancement Therapy (MET) (WMD = 1.22, 95 % CI = 0.28-2.16, p = 0.011, I = 65 %, very low degree of certainty of evidence). The combined effects of cognitive therapy and education on CPAP adherence were inconclusive. Behavioral/supportive interventions improved mean nightly CPAP use in both the short term (WMD = 1.49, 95 % CI = 0.16-2.81, p = 0.029, I = 30 %, very low certainty of evidence) and long-term follow-up (WMD = 1.67, 95 % CI = 1.55-1.79, p = 0, I = 0 %, very low certainty of evidence).
Telemonitoring improved the mean nightly hour of CPAP utilization compared with standard care. Motivational Enhancement Therapy (MET) had the most significant effect on long-term adherence.
持续气道正压通气（CPAP）治疗是阻塞性睡眠呼吸暂停（OSA）综合征的首选治疗方法；然而，改善 CPAP 依从性的干预措施仍不确定。
本研究旨在探讨行为和心理社会干预措施对 CPAP 依从性的影响。
采用 PRISMA 指南和 JBI 系统评价和荟萃分析方法。参与者包括 1）新诊断为 OSA、对 CPAP 治疗无经验的患者；2）通过个体或群体水平提供的任何类型的行为和/或心理社会干预；3）CPAP 依从性作为结果。两名评审员独立选择研究，评估其方法学质量，并提取数据。
对 1657 项研究中的 34 项进行了批判性评价，最终综述纳入了 18 项 RCT。与标准护理相比，远程监测增加了平均每晚的 CPAP 使用时间（WMD=0.76，95%CI=0.31-1.20，p=0.001，I=0%，证据确定性为中等）。动机增强疗法（MET）取得了积极成果（WMD=1.22，95%CI=0.28-2.16，p=0.011，I=65%，证据确定性极低）。认知疗法和教育对 CPAP 依从性的联合作用不确定。行为/支持性干预措施在短期（WMD=1.49，95%CI=0.16-2.81，p=0.029，I=30%，证据确定性极低）和长期随访（WMD=1.67，95%CI=1.55-1.79，p=0，I=0%，证据确定性极低）均改善了平均每晚的 CPAP 使用时间。
与标准护理相比，远程监测提高了平均每晚 CPAP 的使用时间。动机增强疗法（MET）对长期依从性的影响最大。
