Obstructive sleep apnea (OSA) is a prevalent condition that is treated with continuous positive airway pressure (CPAP) therapy, but non-adherence to such therapy is common (17-54%), and is associated with fatal cardiovascular events. Promoting adherence to therapy through peer-driven intervention is cheap and has met with modest success in other chronic medical conditions such as HIV, heart failure and diabetes mellitus. Whether such a peer-driven ("buddy") system (PBS) can improve adherence to CPAP therapy is unknown.
Our overall aim is to assess the feasibility and acceptability of a CPAP adherence program driven by trained "peer-buddies" with sleep apnea. Objective #1: To evaluate patient ratings of the acceptability of the peer buddy system (PBS) in veterans receiving CPAP therapy for OSA. Objective #2: To obtain preliminary data on the effectiveness of PBS on sleep-specific HR-QOL (Functional outcomes in sleep questionnaire [FOSQ]) in veterans receiving CPAP therapy for OSA. Specific Objective #3: To obtain preliminary data on the effect of PBS on CPAP adherence, vigilance, patient activation, and self-efficacy in veterans receiving CPAP therapy for OSA.
We recruited recently diagnosed patients with OSA and randomly assigned them to the peer-buddy system to promote adherence to CPAP therapy (intervention group) or to the usual care (control group). Over a 3-month period, the trained peers shared their experiences on coping strategies, positive experiences, knowledge, methods for improving efficacy of CPAP equipment and prepared their subjects for upcoming healthcare appointments. Measurements at baseline and 30-days included: objective measures of CPAP adherence, sleep-specific HRQOL (Functional outcomes of sleep questionnaire [FOSQ]), vigilance (psychomotor vigilance testing), measures of self-efficacy (outcome expectancy, treatment self-efficacy, and risk perception [SEMSA questionnaire]) and patient activation (Patient Activation Measure [PAM]).
Thirty-nine subjects (22 in intervention arm and 17 in control arm) and 13 "expert" peer buddies were successfully recruited and completed the study. As hypothesized, greater than 90% of the subjects (specifically 91%) were either satisfied (23%) or very satisfied (68%) with the PBS being helpful with regards to managing their disease. Thirty-nine (80%) of the 49 eligible subjects agreed to participate in the 3-month long study suggesting that the PBS was acceptable.
During the 90 days of therapy, weekly CPAP adherence was greater in the intervention than the usual care group (MANOVA; F=2.29; P=0.04). Differences between groups were apparent early, at end of first week of therapy, wherein, CPAP adherence was 313+119 minutes/day in the intervention group tended to be greater than that in the usual care group 238+142 minutes/day (P=0.08). The magnitude of changes in the FOSQ, vigilance, self efficacy or patient activation measures appeared to be favorable towards the intervention group but they did not reach statistical significance.
Our preliminary data suggests that the PBS intervention is feasible and received high patient ratings for satisfaction from veterans with OSA, and our preliminary efficacy data indicates favorable effects on CPAP adherence. Such data derived from this pilot will enable us to submit a grant proposal for a definitive study proposal with the ultimate goal of developing a cheap, effective and exportable system of care to promote CPAP adherence in patients with OSA.
- Parthasarathy S. The need for pharmacovigilance in sleep medicine. Sleep. 2011 Jul 1; 34(7):827-8.