Motivational Enhancement for Increasing Adherence to CPAP: A Randomized Controlled Trial

Area of Science:

• Sleep Medicine
• Cardiovascular Health
• Behavioral Science

Background:

• Obstructive sleep apnea (OSA) management often faces challenges with patient adherence to continuous positive airway pressure (CPAP) therapy.
• Motivational enhancement (ME) is a promising intervention to improve CPAP adherence.
• Individuals with moderate to severe OSA and cardiovascular disease (CVD) or at risk for CVD were the target population.

Purpose of the Study:

• To evaluate the efficacy of motivational enhancement (ME) in improving CPAP adherence among individuals with moderate to severe OSA and CVD risk.
• To compare CPAP adherence between patients receiving CPAP alone versus CPAP with ME.

Main Methods:

• An open-label, randomized controlled trial was conducted with 83 participants aged 45-75.
• Participants received either CPAP alone or CPAP plus standardized ME delivered over 32 weeks.
• Objective CPAP adherence was measured using mixed-effect models, with intention-to-treat analyses.

Main Results:

• Participants receiving CPAP + ME showed an average nightly adherence of 99.0 minutes higher over 6 months compared to CPAP alone (P = .003).
• A subset of 52 participants followed for 12 months demonstrated a consistent adherence difference of 97 minutes/night favoring CPAP + ME (P = .006).
• The study population was predominantly male (67%) with a mean age of 63.9 years and a BMI of 31.1 kg/m².

Conclusions:

• Motivational enhancement, delivered through brief appointments and phone calls, significantly increases CPAP adherence in OSA patients.
• This ME strategy presents a feasible and effective approach for optimizing OSA management.
• Improved CPAP adherence can lead to better health outcomes for individuals with OSA and cardiovascular conditions.