Effectiveness and indications of Educational strategies and Counseling in improving Continuous Positive Airways Pressure compliance

Abstract

Study objective: Continuous Positive Airways Pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA) but adherence limits its effectiveness. Educational and multidimensional strategies seem to be the most effective factors improving adherence. We analyzed data of a severe OSA population in order to evaluate the influence of education intervention and other major factors on CPAP adherence.

Methods: A structured educational program was administered to patients who needed CPAP. Data were collected from clinical interviews, CPAP reports and polysomnography. Factors considered were age, education, type of mask, disease severity, CPAP titration pressure, comorbidity, days required for titration, residual sleepiness, subjective benefit. Outcome measures considered were adherence and mean number of CPAP therapy hours.  Results: Long term adherence was not directly related to longer periods of titration, but cumulative percentage of patients presenting good adherence was related to number of reinforcement talks, with a quadratic relation. Removal of daily sleepiness and subjective symptoms improvement were strongly correlated to good adherence. Moreover good adherence was observed also in patients with oronasal mask and patients with psychiatric or cognitive disorder.

Conclusion: Educational strategies are effective techniques for improving CPAP adherence, also in populations which usually report lower compliance, such as patients without subjective benefit from CPAP and patients with cognitive or psychiatric comorbidity. However shorter educational interventions are recommended.