Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial

Mark S Aloia, J Todd Arnedt, Matthew Strand, Richard P Millman, Belinda Borrelli, Mark S Aloia, J Todd Arnedt, Matthew Strand, Richard P Millman, Belinda Borrelli

Abstract

Background: Obstructive sleep apnea (OSA) is associated with a variety of medical conditions. Positive airway pressure (PAP) is an effective treatment for improving sleep, yet adherence rates are low. The aim of the current study is to test two treatments versus standard care in improving adherence to PAP.

Method: Two hundred twenty-seven patients with OSA were randomized to standard care (SC), education (ED) and motivational enhancement therapy (MET). Adherence was measured objectively and the first week of adherence (prior to the intervention) was used as an a priori moderator of the effect of the various interventions. Mediators of treatment response were also examined using theory-based measures of decisional balance and self-efficacy.

Results: Adherence declined over time for all three groups. There was a significant interaction between level of adherence during the first week of treatment and treatment group. Those who had moderate levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had MET; those who had high levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had ED. MET treatment increased the perception of the positive aspects of PAP, but ED did not.

Conclusions: Initial adherence to positive airway pressure could help guide subsequent treatment plans. The results also support social cognitive theory in that educational approaches might be best suited for those who are ready for change whereas more motivational approaches might be best for those who are ambivalent about change.

Keywords: OSA; adherence; behavioral sleep medicine; psychology.

Figures

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Figure 2
Figure 2
Mean PAP adherence at 12 months based on mixed model fit, by treatment group and week 1 adherence average (low: less than 2 h/night, medium: at least 2 but less than 6 h/night, high: at least 6 h/ night). Error bars extend 1 SE above and below means. See methods for description of variables in the mixed model. *P

Figure 3

Mean decisional balance at 12…

Figure 3

Mean decisional balance at 12 months based on mixed model fit, by treatment…

Figure 3
Mean decisional balance at 12 months based on mixed model fit, by treatment group and week 1 adherence average (low: less than 2 h/night, medium: at least 2 but less than 6 h/night, high: at least 6 h/ night). Error bars extend 1 SE above and below means. (Endpoints for error bars were determined on the transformed scale then inverted back for presentation, yielding shorter upper bars than lower bars, reflecting the left skewed nature of the data.) *P
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Figure 3
Figure 3
Mean decisional balance at 12 months based on mixed model fit, by treatment group and week 1 adherence average (low: less than 2 h/night, medium: at least 2 but less than 6 h/night, high: at least 6 h/ night). Error bars extend 1 SE above and below means. (Endpoints for error bars were determined on the transformed scale then inverted back for presentation, yielding shorter upper bars than lower bars, reflecting the left skewed nature of the data.) *P

Source: PubMed

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