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. 2022 Nov 1;18(11):2627-2634.
doi: 10.5664/jcsm.10180.

Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers

Kelly G Baron  1 , Wendy M Troxel  2 , Saydra Galloway  1 , Shilpi Kharidia  1 , Giulia DeVettori  1 , Allyson Gilles  1 , Krishna M Sundar  3 , Melissa H Watt  4
Affiliations

Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers

Kelly G Baron et al. J Clin Sleep Med. .

Abstract

Study objectives: Bed partners play a critical role in the treatment of obstructive sleep apnea and are affected by the treatment (or lack thereof) of their partner's obstructive sleep apnea, but few studies have included partners formally in treatment. In this qualitative study, we examine key stakeholder perspectives (patient, bedpartner, and sleep medicine provider) to inform the development of a novel, couples-based intervention to promote adherence to positive airway pressure (PAP) and sleep health among older adult couples.

Methods: We conducted 3 focus group discussions with patients with obstructive sleep apnea/using PAP and their partners and 3 focus group discussions with sleep medicine providers. A standard interview guide was used to gather stakeholder input: (1) to understand interdependence of sleep among couples with sleep apnea; (2) to understand collaborative strategies that couples are currently using to address their sleep health challenges, including their perceptions of what is helpful vs not helpful; and (3) feasibility of the intervention design and delivery. Interviews were transcribed and thematically analyzed.

Results: Participants (n = 25) included 9 patients, 7 partners, and 9 providers. Analysis of the discussion identified themes within the 3 topics addressed in the focus group discussions: (1) interdependence of sleep health among couples, (2) collaboration and other dyadic strategies for increasing PAP use, and (3) facilitators and barriers to a couples-based PAP adherence intervention. Results of the focus group discussions provided new insights into collaborative strategies that could be used to enhance the sleep health of both patients and partners. Patient/partners reported that a couples-based treatment could reduce common frustrations experienced by new PAP users, thereby benefiting their relationship. However, barriers to couples-based treatment included patients and partners feeling overwhelmed and reluctance to discuss intimacy. Providers recognized the benefits of involving partners but reported concern about exacerbating conflict in the couple.

Conclusions: Results indicate that couples and providers are enthusiastic about couples-based treatment that addresses their individual and dyadic sleep health challenges and identified important barriers that will need to be addressed to enhance uptake by clinicians and participation/retention of couples.

Citation: Baron KG, Troxel WM, Galway S, et al. Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers. J Clin Sleep Med. 2022;18(11):2627-2634.

Keywords: adherence; continuous positive airway pressure; couples; obstructive sleep apnea; qualitative.

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Conflict of interest statement

All authors have seen and approved this manuscript. Work for this study was performed at the University of Utah. This study was funded by National Institute on Aging Grant 1R21AG067183. The research reported in this publication was supported (in part or in full) by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002538. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have the following conflicts of interest to disclose: K.B. is a consultant for the National Sleep Foundation, W.M.T. is a scientific advisor for Feelmore Labs, OneCare Media, and National Sleep Foundation. She is author of the book Sharing the Covers: Every Couple’s Guide to Better Sleep. K.S. is on the Advisory board for ResMed and Merck Inc. He is also the cofounder of Hypnoscure LLC through the University of Utah Technology commercialization office software designed for population management of sleep apnea.

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