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Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study.

ABSTRACT: Objectives Continuous positive airway pressure (CPAP) therapy has been demonstrated to effectively reverse the abnormal physiology of sleep apnea and improve a variety of patient outcomes, yet helping patients adapt and adhere to CPAP has proven to be a challenging issue in the effective treatment of obstructive sleep apnea (OSA). As a home-based intervention trial, the "Sleep Apnea in Transient Ischemic Attack and Stroke: Reducing Cardiovascular Risk with Positive Airway Pressure" ("sleep tight") study was uniquely positioned to capture and evaluate challenges faced by patients over time during their introduction to CPAP therapy. Methods A comparative case study design was used to better understand the process whereby patients adapted CPAP therapy in order to fit their own personal set of circumstances. Cases were identified from patients enrolled in the "enhanced intervention" group of the sleep tight trial. Results These comparative case studies illustrated how adherence to CPAP therapy is an adaptive process where personal context matters. The case studies also demonstrated how some patients overcame challenges and barriers by themselves to integrate CPAP therapy into their own lives, while others required help from study staff to overcome these barriers and some were never able to successfully adapt CPAP therapy in order to fit their personal contexts, despite study staffs' best efforts. Conclusions A major opportunity to improve CPAP adherence appears to exist in placing greater emphasis on supporting patients in adapting CPAP therapy for "where they live."

SUBMITTER: Miech EJ

PROVIDER: S-EPMC6464984 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study.

Miech Edward J EJ Bravata Dawn M DM Yaggi H Klar HK Austin Charles C Tobias Lauren A LA Ferguson Jared J Matthias Marianne S MS

Cureus 20190215 2

Objectives Continuous positive airway pressure (CPAP) therapy has been demonstrated to effectively reverse the abnormal physiology of sleep apnea and improve a variety of patient outcomes, yet helping patients adapt and adhere to CPAP has proven to be a challenging issue in the effective treatment of obstructive sleep apnea (OSA). As a home-based intervention trial, the "Sleep Apnea in Transient Ischemic Attack and Stroke: Reducing Cardiovascular Risk with Positive Airway Pressure" ("sleep tight ...[more]

PMID: 31019856

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Project description:BackgroundPatients suffering obstructive sleep apnea are mainly treated with continuous positive airway pressure (CPAP). Although it is a highly effective treatment, compliance with this therapy is problematic to achieve with serious consequences for the patients' health. Unfortunately, there is a clear lack of clinical analytical tools to support the early prediction of compliant patients.MethodsThis work intends to take a further step in this direction by building compliance classifiers with CPAP therapy at three different moments of the patient follow-up, before the therapy starts (baseline) and at months 1 and 3 after the baseline.ResultsResults of the clinical trial shows that month 3 was the time-point with the most accurate classifier reaching an f1-score of 87% and 84% in cross-validation and test. At month 1, performances were almost as high as in month 3 with 82% and 84% of f1-score. At baseline, where no information of patients' CPAP use was given yet, the best classifier achieved 73% and 76% of f1-score in cross-validation and test set respectively. Subsequent analyzes carried out with the best classifiers of each time point revealed baseline factors (i.e. headaches, psychological symptoms, arterial hypertension and EuroQol visual analog scale) closely related to the prediction of compliance independently of the time-point. In addition, among the variables taken only during the follow-up of the patients, Epworth and the average nighttime hours were the most important to predict compliance with CPAP.ConclusionsBest classifiers reported high performances after one month of treatment, being the third month when significant differences were achieved with respect to the baseline. Four baseline variables were reported relevant for the prediction of compliance with CPAP at each time-point. Two characteristics more were also highlighted for the prediction of compliance at months 1 and 3.Trial registrationClinicalTrials.gov Identifier, NCT03116958 . Retrospectively registered on 17 April 2017.

Dataset Information

Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study.

Publications

Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study.

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