Mamone, Simon Roger (2014) Psychological Factors Influencing Adherence to Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnoea Patients. PhD thesis, Victoria University.

Abstract

Obstructive sleep apnoea (OSA) is a chronic sleep-related breathing disorder that if left untreated leads to serious adverse health consequences, poor quality of life, and also impacts negatively on society. Continuous positive airway pressure (CPAP) is widely acknowledged as the best available treatment for moderate to severe OSA. CPAP treatment has been linked to reduced co-morbidities as well as improved quality of life. However, adherence to CPAP therapy is a major obstacle to effective long-term treatment. The aim of this study was to explore and identify predictors of CPAP adherence in a sample of patients with moderate to severe OSA. Specifically the study explored; 1) the combination of psychological factors—mood, personality self-efficacy, health locus of control, and health belief—that best predicted adherence and nonadherence to CPAP use; 2) the impact of adherent CPAP use on mood following the implementation phase; and 3) the impact of adherent CPAP use on sleep-related variables collected from polysomnography at the diagnostic phase. Traditionally, much of the research on OSA and treatment adherence has focussed on sleep-related variables that are likely to predict CPAP adherence. In contrast, the current study explored the predictive efficacy of psychological factors. A total of 156 sleep study patients were invited to participate in the present study with 69 adherent patients participating in both the diagnostic and implementation phase and 87 nonadherent patients only participating in the diagnostic phase. The sample comprised mainly of men (65%) diagnosed with moderate to severe OSA, with a mean age of 49 years, and a mean body mass index of 32. Predictor variables included mood, self-efficacy, personality, health locus of control, and health beliefs. Results from a discriminant function analysis revealed that anger/hostility, vigour/activity and depression/dejection on the mood measure and self-efficacy, internal health locus of control, and perceived susceptibility and perceived benefits on the health belief measure were significant predictors accounting for 59% of the variance of CPAP iii adherence. Cross-validated classification showed that the overall predictive accuracy was 88%. The results also showed a positive and strong statistically significant reduction in the Apnoea- Hypopnoea Index as well as a positive and strong statistically significant increase in O2 saturation at implementation of CPAP use that demonstrated that CPAP treatment continues to remain an effective treatment option for OSA sufferers. While more research is still needed to exploring the predictive value of a range of psychological factors in relation to CPAP nonadherence in moderate to severe OSA patients the present study provides initial useful information for predicting adherence and non-adherence. This information is likely to be vital to the development and design of intervention strategies based on the health belief model to increase adherence given the prevalence of OSA and non-adherence to CPAP treatment.

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