Self efficacy predicts adherence to continuous positive airway pressure therapy in obstructive sleep apnea

Abstract

INTRODUCTION: Continuous positive airway pressure (CPAP) therapy is the standard treatment for obstructive sleep apnea (OSA). However, low CPAP adherence limits its treatment effectiveness, and it has been recognized as a contributing factor to poor physiological and psychosocial health in untreated or under-treated OSA patients. This study investigated the relationships between CPAP adherence, biomedical and cognitive factors in subjects with OSA. METHODS: Subjects who were newly diagnosed of OSA and CPAP therapy naïve were recruited. Their demographic, anthropometric and physiological data were obtained after the in-laboratory sleep studies. They filled in Self Efficacy Measure for Sleep Apnea (SEMSA) questionnaire (measuring cognitive perception of risk, outcome expectancies and self-efficacy) in addition to the Epworth Sleepiness Scale (ESS). Fixed CPAP pressure was prescribed after in-laboratory titration as indicated. CPAP adherence was objectively measured at 1 and 4 weeks after CPAP use. RESULTS: 91 subjects (14 females) were evaluated, with mean ± SD age of 52 ± 9 years, body mass index (BMI) of 29 ± 5.6 kg/m2, ESS score of 9 ± 5, apnea-hypopnea index (AHI) of 28.7 (21, 53) /hr. Mean days of CPAP use (>= 4hrs/day) in 1 and 4 weeks were 3.9 ± 2.7 days and 18.9 ± 9.5 days, respectively. On univariate analysis, there were no significant associations between CPAP adherence and clinical parameters (age, gender, BMI, sleep parameters), prescribed CPAP pressure and sleepiness. Self-efficacy score of cognitive perception measured before the start of CPAP therapy was associated with CPAP use in 1 week (ß=1.272 (0.556, 1.987)) and 4 weeks (ß= 4.163 (1.462, 6.863)), but not risk perception and outcome expectancies. Multiple linear analysis showed self-efficacy score is a significant predictor of CPAP adherence at 1 and 4 weeks after adjusting for age, gender and OSA severity. CONCLUSIONS: Self efficacy score of cognitive perception is a significant predictor of adherence to CPAP therapy in OSA.