Sleep and Breathing

, Volume 15, Issue 4, pp 687–694 | Cite as

Personality correlates of adherence with continuous positive airway pressure (CPAP)

  • Alicia M. Moran
  • Daniel Erik Everhart
  • Claude Ervin Davis
  • Karl L. Wuensch
  • Daniel O. Lee
  • Heath A. Demaree
Original Article

Abstract

Introduction

Adherence with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) has been problematic. Understanding the factors associated with nonadherence may assist with psychosocial interventions.

Objective

The objective of this study was to examine the relationship between adherence and three measures of personality and coping strategies.

Methods

Ratings on the behavioral inhibition system/behavioral activation system (BIS/BAS) scales, the ways of coping inventory, and a broad personality measure (mini-IPIP) were analyzed with a binary logistic regression among 63 subjects, adult men (31) and women (32), diagnosed with OSA. Data from the CPAP device was obtained following initial 30 days at minimum, with adherence defined as >4 h/night on 70% of nights.

Results

Elevated BIS was the strongest predictor of nonadherence (r = −.452, p < .01), followed by neuroticism. The regression correctly classified 73% of participants as adherent or nonadherent.

Conclusion

Nonadherence is associated with elevated BIS scores and neuroticism, which indicates that personality factors play a role in determining adherence to CPAP. Although more research is needed to draw firm conclusions, the differences noted in BIS may also point toward differences in neurophysiological function. The BIS scale may be a useful tool for predicting nonadherence and assist with the development of intervention strategies that will increase adherence.

Keywords

Obstructive sleep apnea Continuous positive airway pressure adherence Behavioral inhibition Behavioral activation Ways of coping Mini-IPIP Big 5 

References

  1. 1.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. New Engl J Med 328(17):1230–1235PubMedCrossRefGoogle Scholar
  2. 2.
    Krishnan V, Collop NA (2006) Gender differences in sleep disorders. Curr Opin Pulm Med 12(6):383–389PubMedCrossRefGoogle Scholar
  3. 3.
    Kripke DF, AncoliIsrael S, Klauber MR, Wingard DL, Mason WJ, Mullaney DJ (1997) Prevalence of sleep-disordered breathing in ages 40–64 years: a population-based survey. Sleep 20(1):65–76PubMedGoogle Scholar
  4. 4.
    Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG, Sleep Heart Hlth S (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA 283(14):1829–1836PubMedCrossRefGoogle Scholar
  5. 5.
    Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM, Sleep Heart Health Study Research Group (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study. Am J Resp Crit Care Med 163(1):19–25PubMedGoogle Scholar
  6. 6.
    Quan SF, Wright R, Baldwin CM, Kaemingk KL, Goodwin JL, Kuo TF, Kaszniak A, Boland LL, Caccappolo E, Bootzin RR (2006) Obstructive sleep apnea–hypopnea and neurocognitive functioning in the Sleep Heart Health Study. Sleep Med 7(6):498–507PubMedCrossRefGoogle Scholar
  7. 7.
    Masa JF, Rubio M, Findley LJ (2000) Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Resp Crit Care Med 162(4 Pt 1):1407–1412PubMedGoogle Scholar
  8. 8.
    Young T, Blustein J, Finn L, Palta M (1997) Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 20(8):608–613PubMedGoogle Scholar
  9. 9.
    Kryger MH, Roth T, Dement WC (2000) Principles and practice of sleep medicineGoogle Scholar
  10. 10.
    Aloia MS, Arnedt JT, Smith L, Skrekas J, Stanchina M, Millman RP, Aloia MS, Arnedt JT, Smith L, Skrekas J, Stanchina M, Millman RP (2005) Examining the construct of depression in obstructive sleep apnea syndrome. Sleep Med 6(2):115–121PubMedCrossRefGoogle Scholar
  11. 11.
    Hoekema A, Stel AL, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, de Bont LG (2007) Sexual function and obstructive sleep apnea–hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med 4(4 Pt 2):1153–1162PubMedCrossRefGoogle Scholar
  12. 12.
    Wiese HJ, Boethel C, Phillips B, Wilson JF, Peters J, Viggiano T (2005) CPAP compliance: video education may help! Sleep Med 6(2):171–174CrossRefGoogle Scholar
  13. 13.
    Engleman H, Wild M (2003) Improving CPAP use by patients with the sleep apnea/hypoapnea (SAHS). Sleep Med Rev 7:81–99PubMedCrossRefGoogle Scholar
  14. 14.
    Chervin RD, Theut S, Bassetti C, Aldrich MS (1997) Compliance with nasal CPAP can be improved by simple interventions. Sleep 20(4):284–289PubMedGoogle Scholar
  15. 15.
    Edinger JD, Carwile S, Miller P, Hope V, Mayti C (1994) Psychological status, syndromatic measures, and compliance with nasal CPAP therapy for sleep apnea. Percept Mot Skills 78(3 Pt 2):1116–1118PubMedCrossRefGoogle Scholar
  16. 16.
    Brostrom A, Stromberg A, Martensson J, Ulander M, Harder L, Svanborg E, Brostrom A, Stromberg A, Martensson J, Ulander M, Harder L, Svanborg E (2007) Association of type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS. J Sleep Res 16(4):439–447PubMedCrossRefGoogle Scholar
  17. 17.
    Carver CS, White TL (1994) Behavioral-inhibition, behavioral activation, and affective responses to impending reward and punishment—the BIS BAS scales. J Pers Soc Psychol 67(2):319–333CrossRefGoogle Scholar
  18. 18.
    Amodio DM, Master SL, Yee CM, Taylor SE (2008) Neurocognitive components of the behavioral inhibition and activation systems: implications for theories of self-regulation. Psychophysiology 45(1):11–19PubMedGoogle Scholar
  19. 19.
    Gable SL, Reis HT, Elliot AJ (2000) Behavioral activation and inhibition in everyday life. J Pers Soc Psychol 78(6):1135–1149PubMedCrossRefGoogle Scholar
  20. 20.
    Depue RA, Iacono WG (1989) Neuro-behavioral aspects of affective-disorders. Ann Rev Psychol 40:457–492CrossRefGoogle Scholar
  21. 21.
    Fowles DC (1994) A motivational theory of psychopathology. In: Integrative views of motivation, cognition and emotion. Univ Nebraska Press, Lincoln. p 181–238Google Scholar
  22. 22.
    Stepnowsky CJ, Bardwell WA, Moore PJ, Ancoli-Israel S, Dimsdale JE (2002) Psychologic correlates of compliance with continuous positive airway pressure. Sleep 25(7):758–762PubMedGoogle Scholar
  23. 23.
    Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Redline S, Henry JN, Getsy JE, Dinges DF (1993) Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep–apnea. Am Rev Respir Dis 147(4):887–895PubMedGoogle Scholar
  24. 24.
    Rolfe I, Olson LG, Saunders NA (1991) Long-term acceptance of continuous positive airway pressure in obstructive sleep-apnea. Am Rev Respir Dis 144(5):1130–1133PubMedCrossRefGoogle Scholar
  25. 25.
    Goldberg LR (1999) A broad-bandwidth, public-domain, personality inventory measuring the lower-level facets of several five-factor models. Personal psychol Eur 7:7–28Google Scholar
  26. 26.
    Donnellan MB, Oswald FL, Baird BM, Lucas RE (2006) The mini-IPIP scales: tiny-yet-effective measures of the big five factors of personality. Psychol Assess 18(2):192–203PubMedCrossRefGoogle Scholar
  27. 27.
    Christensen AJ, Smith TW (1995) Personality and patient adherence—correlates of the 5-factor model in renal dialysis. J Behav Med 18(3):305–313PubMedCrossRefGoogle Scholar
  28. 28.
    Moran PJ, Christensen AJ, Lawton WJ (1997) Social support and conscientiousness in hemodialysis adherence. Ann Behav Med 19(4):333–338PubMedCrossRefGoogle Scholar
  29. 29.
    Stepnowsky CJ, Marler MR, Palau J, Annette Brooks J (2006) Social-cognitive correlates of CPAP adherence in experienced users. Sleep Med 7(4):350–356PubMedCrossRefGoogle Scholar
  30. 30.
    Aloia MS, Arnedt JT, Riggs RL, Hecht J, Borrelli B, Aloia MS, Arnedt JT, Riggs RL, Hecht J, Borrelli B (2004) Clinical management of poor adherence to CPAP: motivational enhancement. Behav Sleep Med 2(4):205–222PubMedCrossRefGoogle Scholar
  31. 31.
    Aloia MS, Arnedt JT, Stepnowsky C, Hecht J, Borrelli B, Aloia MS, Arnedt JT, Stepnowsky C, Hecht J, Borrelli B (2005) Predicting treatment adherence in obstructive sleep apnea using principles of behavior change. J Clin Sleep Med 1(4):346–353PubMedGoogle Scholar
  32. 32.
    Muris P (2001) Relationships between self-efficacy and symptoms of anxiety disorders and depression in a normal adolescent sample. Pers Individ Differ 32(2):337–348CrossRefGoogle Scholar
  33. 33.
    Williams PG, O’Brien CD, Colder CR (2004) The effects of neuroticism and extraversion on self-assessed health and health-relevant cognition. Pers Individ Differ 37(1):83–94CrossRefGoogle Scholar
  34. 34.
    Coan JA, Allen JJB (2003) Frontal EEG asymmetry and the behavioral activation and inhibition systems. Psychophysiology 40(1):106–114PubMedCrossRefGoogle Scholar
  35. 35.
    Harmon-Jones E (2003) Anger and the behavioral approach system. Pers Individ Differ 35(5):995–1005CrossRefGoogle Scholar
  36. 36.
    Tomarken AJ, Davidson RJ, Wheeler RE, Doss R (1992) Individual differences in anterior brain asymmetry and fundamental dimensions of emotion. J Pers Soc Psychol 62:676–687PubMedCrossRefGoogle Scholar
  37. 37.
    Tomarken AJ, Davidson RJ, Henriques JB (1990) Resting frontal brain asymmetry predicts affective responses to films. J Pers Soc Psychol 59:791–801PubMedCrossRefGoogle Scholar
  38. 38.
    Rosenthal L, Gerhardstein R, Lumley A, Guido P, Day R, Syron ML, Roth T (2000) CPAP therapy in patients with mild OSA: implementation and treatment outcome. Sleep Med 1(3):215–220PubMedCrossRefGoogle Scholar
  39. 39.
    Janson C, Noges E, Svedberg-Brandt S, Lindberg E (2000) What characterizes patients who are unable to tolerate continuous positive airway pressure (CPAP) treatment? Respir Med 94(2):145–149PubMedCrossRefGoogle Scholar
  40. 40.
    Delguste P, Rodenstein DO (2000) Compliance, education, monitoring in the treatment of obstructive sleep apnea by nasal continuous positive airway pressure. Sleep 23:S158–S160PubMedGoogle Scholar
  41. 41.
    Aloia MS, Arnedt JT, Stanchina M, Millman RP, Aloia MS, Arnedt JT, Stanchina M, Millman RP (2007) How early in treatment is PAP adherence established? Revisiting night-to-night variability. Behav Sleep Med 5(3):229–240PubMedCrossRefGoogle Scholar
  42. 42.
    Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P, Saunders V, Hudgel DW (2007) Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 30(3):320–324PubMedGoogle Scholar
  43. 43.
    Weaver TE, Kribbs NB, Pack AI, Kline LR, Chugh DK, Maislin G, Smith PL, Schwartz AR, Schubert NM, Gillen KA, Dinges DF (1997) Night-to-night variability in CPAP use over the first 3 months of treatment. Sleep 20(4):278–283PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Alicia M. Moran
    • 1
    • 2
  • Daniel Erik Everhart
    • 1
    • 2
  • Claude Ervin Davis
    • 1
  • Karl L. Wuensch
    • 1
  • Daniel O. Lee
    • 2
  • Heath A. Demaree
    • 3
  1. 1.Department of PsychologyEast Carolina UniversityGreenvilleUSA
  2. 2.Pitt County Memorial Hospital Sleep CenterGreenvilleUSA
  3. 3.Department of PsychologyCase Western Reserve UniversityClevelandUSA

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