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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3096 — Effect of a Self-Management Intervention on CPAP Adherence

Stepnowsky C (VA San Diego Healthcare System), Zamora T (VA San Diego Healthcare System), Gifford A (VA New England Healthcare), Groessl E (VA San Diego Healthcare System), Anocoli-Israel S (University of California San Diego, Department of Psychiatry), Loredo J (VA San Diego Healthcare System)

Objectives:
CPAP is the gold-standard treatment for OSA and it is generally accepted that adherence to CPAP can be substantially improved. A key advantage to using CPAP is its ability to objectively measure and store both treatment efficacy and adherence data. Unfortunately, under usual and customary care, there is generally a time lag ranging from days to weeks between adherence data collection and data availability to care providers.

Methods:
The Sleep Apnea Self-Management Program (SASMP) is a group-based self-management intervention desiged for incorporation into sleep clinical care processes. It includes information that is both specific to OSA and common across chronic illnesses. A major focus of SASMP is on developing strategies to solve problems patients commonly experience with CPAP and it utilizes a variety of different activities, including mini-lectures, brainstorming, action planning, and problem-solving. The study was a randomized, controlled trial of Usual Care compared to SASMP. Only new CPAP patients were included in this study.

Results:
240 patients diagnosed with OSA and prescribed CPAP were studied. At baseline, mean age = 58.1±12.3, mean apnea-hypopnea index (AHI) = 37.5±20, and mean body mass index (BMI) = 33.4±6.3 (mean±SD). There were no baseline differences in AHI or BMI between the groups. Nightly CPAP adherence measured at the 1-month timepoint was 2.7±2.6 and 3.8±2.4 hrs/night (p = .001) and at the 6-month timepoint was 2.3±2.5 and 3.1±2.5 hrs/night (p = .023) for UC and SASMP, respectively. The groups differed on measures of social-cognitive theory, including outcome expectations (-.21 vs. .05, p = .03) and self-efficacy (-.39 vs. .07; p = .001) (UC vs. SM, respectively).

Implications:
The Sleep Apnea Self-Management Program resulted in higher CPAP adherence and self-efficacy when compared to Usual Care.

Impacts:
Self-management education has the potential to be an effective and practical way to improve CPAP adherence. Key advantages of the self-management intervention are that it can be easily taught to sleep apnea patients, and helps them focus on troubleshooting problems collaboratively with their sleep disorder treatment providers. This intervention has the potential to help patients better manage their OSA by helping to establish optimal and enduring patterns of CPAP treatment adherence from very early in the treatment initialization process.


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