Educational video combined with augmented clinical support to improve CPAP use in patients with obstructive sleep...

Poor patient adherence to continuous positive airway pressure (CPAP) remains a common challenging issue and a major cause of treatment failure in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Our study aims to test the hypothesis that therapeutic patient education (TPE) combined with augmented clinical support (ACS) at CPAP initiation would improve CPAP adherence and treatment outcomes compared to usual care.

We will perform a prospective, randomized, controlled, parallel-group trial including 60 adult patients newly diagnosed with severe OSAHS. Each patient will be randomly assigned to either the TPE group or the usual care group and then scheduled to start CPAP therapy within 1-2 weeks after the nocturnal polygraph recording. For the TPE group, CPAP initiation will be performed at the hospital during a 3-hour educational session that will include 4 workshops entitled: "What's OSAHS", "CPAP machine: what is it? How does it work? And what does it serve for?", "How to use your CPAP and fit your mask" and "How to deal with CPAP side effects". The educational team will include a sleep disorders specialist, a sleep nurse, and a CPAP technician. As educational tools, we will use a short storytelling video in the local language, live demonstrations and a daily desk calendar with 60 removable sheets and 1 tip on CPAP therapy on each sheet. Patients assigned to the usual care group will undergo CPAP initiation at home under the guidance of a CPAP technician and will not receive additional educational support beyond the documents provided by the manufacturers. Our primary outcome is unadjusted CPAP adherence measured in hours/night at 1, 3, and 6 months after CPAP initiation. Our secondary outcome is functional status at the 6-month follow-up, which included snoring, nasal obstruction symptoms, subjective quality of life, fatigue, emotional status, cognitive function, insomnia and excessive daytime sleepiness (EDS).

We designed this original protocol by combining TPE with ACS. We hope that our findings will help us improve CPAP adherence among Tunisian patients with OSAHS.