Table 3.
Intervention Strategies to Promote CPAP* Adherence
| Intervention Strategy & Description | Impact on CPAP Adherence | Caveat |
|---|---|---|
| Educational | NS* | No stand-alone patient education intervention has been effective |
| •Reinforced education by prescriber | ||
| •Reinforced education by homecare provider | May influence patients’ return to clinical follow-up | |
| •One-day education program using video, demonstration, and discussion + spouse in established CPAP users | All effective interventions that follow included patient education | |
| •Simple video education | ||
|
| ||
| Technological | Pilot studies with relatively small sample sizes with negative results; Large trial with positive results | |
| •Telephone-linked communication | + in new CPAP users at 6 months and 12 months | |
| •Telehealth program | + in experienced users at 12 weeks | |
| •Tele-monitoring of CPAP treatment data | NS | Most technological intervention strategies were not statistically effective for CPAP adherence but effect sizes and trend toward statistical significance suggest these may be effective strategies if tested in full studies |
| •Internet-based information, support, and feedback system | NS | |
|
| ||
| Psychosocial | Delivery of CBT prior to home treatment use effective for increasing initial acceptance of CPAP (i.e., starting treatment) and 1 month CPAP adherence CBT may reduce rates of quitting treatment after initiation |
|
| •CBT* | + delivered to small groups, including partners/spouses + effect on discontinuation of CPAP |
|
|
| ||
| Pharmacological | One published study | |
| •Nonbenzodiazepine sedative-hypnotic agent | + eszopiclone 3mg nightly first 14 days of initial CPAP treatment with higher CPAP use at 6 months | May improve sleep quality, relaxation during initial treatment exposure |
|
| ||
| Multidimensional | Intensive home- and sleep- laboratory-support effective for longer-term CPAP adherence | |
| •Intensive support | + for higher CPAP adherence at 6 months | |
| •Combination including education, relaxation, and CPAP habituation | + at 1 month for higher CPAP adherence but not longer term | Consideration of costs important for translation |
*
CPAP – Continuous Positive Airway Pressure; NS – Not Significant; CBT – Cognitive Behavior Therapy