Adherence to APAP in obstructive sleep apnea syndrome: effectiveness of a motivational intervention

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is a serious disorder with significant health consequences. Treatment adherence to auto-titrating positive airway pressure (APAP) is often below expectations. We investigated the effectiveness of a brief educational intervention using motivational strategies in treatment adherence among patients with OSAS.

Methods: The study followed a randomized, controlled design and included 61 patients diagnosed with OSAS, meeting the criteria for APAP therapy. Patients recruited from a Sleep Disorders Unit were randomly allocated to an intervention group (IG) and two control groups (CG1 and CG2). In the IG motivational strategies were applied according to patient's motivation, assessed by the degree of confidence and conviction. In the CG1, participants received exclusively standardized information, and in the CG2, routine procedures were followed. Assessment included the Apnea Hypopnea Index (AHI), the Epworth Sleepiness Scale (ESS), and sociodemographic and clinical information. Adherence to treatment was measured after 1 (T1) and 2 months (T2) through the APAP software.

Results: The IG presented higher adherence to APAP-percentage of days of use >4 h (89.8 % p = 0.013), mean effective use per effective day (6.2 p = 0.000), and lower AHI (2.7 p = 0.019) at T2 when compared with the other two groups. Confidence was higher in the IG group at T2 than at T1 (p = 0.000). The ESS presented a significant reduction (p = 0.000) in the IG and in the CG1 (p = 0.008), but was higher in the CG2 (p = 0.015).

Conclusions: Brief interventions using motivational strategies can improve a patient's adherence to APAP.