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Motivational Interviewing Effects on Positive Airway Pressure Therapy (PAP) Adherence: A Systematic Review and
Eric S Crosby1, Elizabeth G Spitzer2, Jan Kavookjian3
1Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA.
Motivational Interviewing (MI) moderately improves positive airway pressure (PAP) adherence in new users with obstructive sleep apnea (OSA) for up to three months. This strategy shows promise for enhancing short-term PAP use in this population.
Area of Science:
- Sleep Medicine
- Behavioral Science
Background:
- Obstructive sleep apnea (OSA) affects millions globally, with positive airway pressure (PAP) therapy being a primary treatment.
- Adherence to PAP therapy remains a significant challenge, impacting treatment efficacy.
- Motivational Interviewing (MI) is a behavioral counseling approach that may enhance adherence.
Approach:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searched multiple databases (Medline, CIHANL, Psych Info, Web of Science, PubMed, Cochrane) for English-language RCTs published between 1990 and 2021.
- Included studies compared objective PAP adherence in adults with OSA receiving MI versus non-MI interventions, analyzing data using a random effects model.
Key Points:
- MI demonstrated a small to moderate significant effect on PAP adherence in PAP-naïve participants at 1, 2, and 3 months (Hedges' g = 0.38 to 0.48).
- Some trials showed increased PAP use (1-2.6 hours/night) with MI in naïve users, while others found comparable results.
- MI did not significantly improve adherence or secondary outcomes in non-naïve PAP users.
Conclusions:
- Motivational Interviewing is a moderately effective strategy for improving short-term (1-3 months) PAP adherence in adults with moderate-to-severe OSA who are new to PAP therapy.
- Further research may be needed to optimize MI interventions for long-term adherence and for non-naïve PAP users.
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