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Parthasarathy S, Wendel C, Haynes PL, Atwood CW, Kuna ST. A pilot study of CPAP adherence promotion by peer buddies with sleep apnea. Paper presented at: American Thoracic Society Annual International Conference; 2012 May 21; San Francisco, CA.
Introduction: Poor adherence to continuous positive airway pressure (CPAP) therapy is associated with increased risk for fatal and non-fatal cardiovascular events in patients with obstructive sleep apnea (OSA). Promoting adherence to therapy through peer-driven intervention is cheap and has met with modest success in other chronic conditions such as HIV, heart failure and diabetes mellitus. Whether such a peer-driven ("buddy") system can improve adherence to CPAP therapy is unknown. We proposed to evaluate patient ratings of the acceptability of a peer buddy system (PBS) to promote CPAP therapy adherence in patients with OSA. We also aimed to obtain preliminary data on the effectiveness of PBS on sleep-specific health-related quality of life and CPAP adherence. Methods: Prospective, randomized, controlled study in an academic center. Thirty-nine recently diagnosed patients with OSA were randomly assigned to either the PBS (intervention; n = 22) or usual care group (controls; n = 17). Patient satisfaction, Functional Outcomes of Sleep Questionnaire [FOSQ], CPAP adherence, vigilance, self-efficacy and patient activation was measured. Results: Ninety-one percent of the subjects rated the PBS as either satisfactory (23%) or very satisfactory (68%). 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 group were apparent early, at end of first week of therapy, wherein, CPAP adherence was 313+119 minutes/day (5.2+2.0 hours/day) in the intervention group tended to be greater than that in the usual care group (238+142 minutes/day or 4.0+2.4 hours/day; P = 0.08). We did not find any group differences for FOSQ, vigilance, self efficacy or patient activation in this small pilot study. Conclusion: Our pilot study suggests that the PBS intervention is feasible and received high patient satisfaction ratings. CPAP adherence may be improved by peer-driven intervention, but a larger, adequately powered study is needed.