Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS)

Though continuous positive airway pressure (CPAP) is the treatment of choice for the sleep apnoea/hypopnoea syndrome (SAHS), suboptimal adherence to CPAP is common. Internationally, some 5-50% of SAHS patients recommended for CPAP either reject this treatment option or discontinue within the first week, and 12-25% of remaining patients can be expected to have discontinued CPAP by 3 years. Biomedical investigations of patients' CPAP use reveal frequent adverse effects, weak prospective relationships between symptomatic or physiological disease severity and CPAP use, and moderate correlations between use and benefit. Relatively expensive high-technological interventions to improve CPAP use (e.g. "intelligent" CPAP, humidification) are the subject of several well-conducted studies favouring their effectiveness. More basic educational and behavioural supports, and low-technological interventions (e.g. chinstraps, mask re-fitting) appear valued, but are currently less rigorously evaluated. In other diseases with demanding treatment regimens, cognitive constructs including health attitudes and beliefs (health value, locus of control, chance, powerful others, self-efficacy) and mental and physical health status are significant predictors of adherence. The enhancement of multidisciplinary models with psychosocial interpretations may provide increased explanatory and interventional potential in models of CPAP use. While acknowledging the scarcity of evidence, a structured, multidisciplinary, cost-efficient model is suggested, containing educational, behavioural and technological components as basic support, and with high-expertise cognitive-behavioural intervention in more difficult cases of low CPAP use.