TY - JOUR
T1 - Adherence to CPAP
T2 - What Should We Be Aiming For, and How Can We Get There?
AU - Bakker, Jessie P.
AU - Weaver, Terri E.
AU - Parthasarathy, Sairam
AU - Aloia, Mark S.
N1 - Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. S. A. is a full-time employee and stakeholder of Philips. J. P. B. is a full-time employee of Philips, which is a company that focuses on sleep and respiratory care. J. P. B. holds a part-time appointment at Brigham and Women’s Hospital. The interests of J. P. B. were reviewed and are managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies. J. P. B. reports grant funding from the National Institutes of Health (NIH) (co-investigator). M. S. A. reports grant funding from the NIH (principal investigator and co-investigator). T. E. W. receives personal fees from UpToDate and royalty fees for use of the Functional Outcome of Sleep Questionnaire from Philips Respironics, Nyxoah, ResMed, Jazz Pharmaceuticals, Bayer AG, NightBalance, and Cook Medical; she received grant funding from Jazz Pharmaceuticals as a site for a pharmaceutical clinical trial. S. P. reports grants from the NIH/National Heart, Lung, and Blood Institute, Patient Centered Outcomes Research Institute, US Department of Defense, NIH (National Cancer Institute), and Johrei Institute; personal fees from the American Academy of Sleep Medicine; nonfinancial support from the National Center for Sleep Disorders Research of the NIH (National Heart, Lung, and Blood Institute); personal fees from UpToDate, Philips Respironics, Merck, and Vapotherm; and grants from Younes Sleep Technologies, Niveus Medical, and Philips Respironics, outside the submitted work. In addition, S. P. has a patent (UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 [home breathing device]).
Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. S. A. is a full-time employee and stakeholder of Philips. J. P. B. is a full-time employee of Philips, which is a company that focuses on sleep and respiratory care. J. P. B. holds a part-time appointment at Brigham and Women's Hospital. The interests of J. P. B. were reviewed and are managed by Brigham and Women's Hospital and Partners HealthCare in accordance with their conflict of interest policies. J. P. B. reports grant funding from the National Institutes of Health (NIH) (co-investigator). M. S. A. reports grant funding from the NIH (principal investigator and co-investigator). T. E. W. receives personal fees from UpToDate and royalty fees for use of the Functional Outcome of Sleep Questionnaire from Philips Respironics, Nyxoah, ResMed, Jazz Pharmaceuticals, Bayer AG, NightBalance, and Cook Medical; she received grant funding from Jazz Pharmaceuticals as a site for a pharmaceutical clinical trial. S. P. reports grants from the NIH/National Heart, Lung, and Blood Institute, Patient Centered Outcomes Research Institute, US Department of Defense, NIH (National Cancer Institute), and Johrei Institute; personal fees from the American Academy of Sleep Medicine; nonfinancial support from the National Center for Sleep Disorders Research of the NIH (National Heart, Lung, and Blood Institute); personal fees from UpToDate, Philips Respironics, Merck, and Vapotherm; and grants from Younes Sleep Technologies, Niveus Medical, and Philips Respironics, outside the submitted work. In addition, S. P. has a patent (UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 [home breathing device]).
Publisher Copyright:
© 2019
PY - 2019/6
Y1 - 2019/6
N2 - The purpose of this review was to summarize what is currently known regarding two important questions facing the field of sleep medicine today: (1) How many hours of CPAP use per night are necessary to improve daytime symptoms and reduce cardiovascular risk associated with OSA?; and (2) What strategies could be implemented to optimize adherence in clinical settings? Despite the widespread adoption of a threshold approach to CPAP management, the literature to date suggests a dose-response relationship between CPAP usage and a range of outcomes, including sleepiness, functional status, and BP; the data also suggest that the optimal adherence level differs depending on the outcome in question. Over the years, psychological measures of behavior change constructs have been increasingly recognized as the most consistent predictors of CPAP adherence, and, as such, the most successful interventions for optimizing adherence have been behavioral in nature. Unfortunately, behavioral therapies have not been translated from highly controlled research settings to comparative-effectiveness studies and finally into routine care, mainly due to feasibility and cost issues. More recently, theory-driven telemedicine adherence interventions have emerged, which take advantage of the framework that already exists in the United States and elsewhere for real-time remote-monitoring of CPAP. Combining theory-driven behavioral approaches with telemedicine technology could hold the answer to increasing real-world CPAP adherence rates, although randomized studies are still required, and socioeconomic barriers to telemedicine will need to be addressed to promote health equity.
AB - The purpose of this review was to summarize what is currently known regarding two important questions facing the field of sleep medicine today: (1) How many hours of CPAP use per night are necessary to improve daytime symptoms and reduce cardiovascular risk associated with OSA?; and (2) What strategies could be implemented to optimize adherence in clinical settings? Despite the widespread adoption of a threshold approach to CPAP management, the literature to date suggests a dose-response relationship between CPAP usage and a range of outcomes, including sleepiness, functional status, and BP; the data also suggest that the optimal adherence level differs depending on the outcome in question. Over the years, psychological measures of behavior change constructs have been increasingly recognized as the most consistent predictors of CPAP adherence, and, as such, the most successful interventions for optimizing adherence have been behavioral in nature. Unfortunately, behavioral therapies have not been translated from highly controlled research settings to comparative-effectiveness studies and finally into routine care, mainly due to feasibility and cost issues. More recently, theory-driven telemedicine adherence interventions have emerged, which take advantage of the framework that already exists in the United States and elsewhere for real-time remote-monitoring of CPAP. Combining theory-driven behavioral approaches with telemedicine technology could hold the answer to increasing real-world CPAP adherence rates, although randomized studies are still required, and socioeconomic barriers to telemedicine will need to be addressed to promote health equity.
KW - CPAP
KW - adherence
KW - behavioral therapy
KW - sleep apnea
UR - http://www.scopus.com/inward/record.url?scp=85063762071&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063762071&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2019.01.012
DO - 10.1016/j.chest.2019.01.012
M3 - Review article
C2 - 30684472
AN - SCOPUS:85063762071
SN - 0012-3692
VL - 155
SP - 1272
EP - 1287
JO - CHEST
JF - CHEST
IS - 6
ER -