Skip to main content
SpringerLink
Log in

Self-efficacy contributes to individual differences in subjective improvements using CPAP

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Continuous positive airway pressure (CPAP) improves depressive symptoms and daytime sleepiness in patients with obstructive sleep apnea (OSA). However, there is variability in response to CPAP. This study examined individual differences in the daily associations between CPAP use and improvements in affect and sleepiness patients beginning CPAP.

Methods

This observational repeated measures study involved 31 CPAP-naïve patients diagnosed with obstructive sleep apnea at an academic sleep disorders center. Patients completed pre-treatment assessments of OSA knowledge, expectations for CPAP, and treatment self-efficacy as well as a repeated daily assessment of positive affect and negative affect, sleepiness/fatigue, and CPAP adherence for 10 days beginning the first week of treatment. Data were analyzed using multilevel modeling.

Results

Nightly CPAP adherence predicted improvements in next-day positive affect, negative affect, and sleepiness/fatigue. The apnea-hypopnea index (AHI), treatment self-efficacy, and outcome expectancies were significant moderators of day-to-day improvement. Higher self-efficacy and lower AHI were associated with a stronger relationship between adherence and next-day improvements in positive affect and sleepiness. Very high-outcome expectances were associated with a weaker relationship between adherence and next-day improvements in sleepiness. Subjective sleepiness at pre-treatment did not give moderate improvements in next-day affect.

Conclusions

Although CPAP use predicted daily improvements in affect and sleepiness for the majority of patients, patients with lower AHI, greater treatment self-efficacy, and moderate outcome expectancies reported stronger daily benefits from CPAP. For patients with high-treatment efficacy, adherence may be reinforced by a stronger link between adherence and daily improvements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT (2003) Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med 163(5):565–571

    Article  PubMed  Google Scholar 

  2. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053

    PubMed  Google Scholar 

  3. Means MK, Lichstein KL, Edinger JD, Taylor DJ, Durrence HH, Husain AM et al (2003) Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Breath 7(1):31–42

    Article  PubMed  Google Scholar 

  4. Engleman HM, Asgari-Jirhandeh N, McLeod AL, Ramsay CF, Deary IJ, Douglas NJ (1996) Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. Chest 109(6):1470–1476

    Article  PubMed  CAS  Google Scholar 

  5. Engleman HM, Martin SE, Douglas NJ (1994) Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 49(3):263–266

    Article  PubMed  CAS  Google Scholar 

  6. Sin DD, Mayers I, Man GC, Pawluk L (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121(2):430–435

    Article  PubMed  Google Scholar 

  7. 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 5:229–240

    Article  PubMed  Google Scholar 

  8. Weaver TE, Chasens ER (2007) Continuous positive airway pressure treatment for sleep apnea in older adults. Sleep Med Rev 11(2):99–111

    Article  PubMed  Google Scholar 

  9. Weaver TE, Kribbs NB, Pack AI, Kline LR, Chugh DK, Maislin G et al (1997) Night-to-night variability in CPAP use over the first 3 months of treatment. Sleep 20(4):278–283

    PubMed  CAS  Google Scholar 

  10. Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5(2):173–178

    Article  PubMed  Google Scholar 

  11. Hui DS, Choy DK, Li TS, Ko FW, Wong KK, Chan JK et al (2001) Determinants of continuous positive airway pressure compliance in a group of Chinese patients with obstructive sleep apnea. Chest 120(1):170–176

    Article  PubMed  CAS  Google Scholar 

  12. Meurice JC, Dore P, Paquereau J, Neau JP, Ingrand P, Chavagnat JJ et al (1994) Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome. Chest 105(2):429–433

    Article  PubMed  CAS  Google Scholar 

  13. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(4 Pt 1):1108–1114

    PubMed  CAS  Google Scholar 

  14. Stepnowsky CJ Jr, Marler MR, Palau J, Annette Brooks J (2006) Social-cognitive correlates of CPAP adherence in experienced users. Sleep Med 7(4):350–356

    Article  PubMed  Google Scholar 

  15. 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):346–353

    PubMed  Google Scholar 

  16. Bedard MA, Montplaisir J, Malo J, Richer F, Rouleau I (1993) Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with continuous positive airways pressure (CPAP). J Clin Exp Neuropsychol 15(2):330–341

    Article  PubMed  CAS  Google Scholar 

  17. Sforza E, Krieger J (1992) Daytime sleepiness after long-term continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea syndrome. J Neurol Sci 110(1–2):21–26

    Article  PubMed  CAS  Google Scholar 

  18. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H et al (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30(6):711–719

    PubMed  Google Scholar 

  19. Wells RD, Freedland KE, Carney RM, Duntley SP, Stepanski EJ (2007) Adherence, reports of benefits, and depression among patients treated with continuous positive airway pressure. Psychosom Med 69(5):449–454

    Article  PubMed  Google Scholar 

  20. Bolger N, Davis A, Rafaeli E (2003) Diary methods: capturing life as it is lived. Annu Rev Psychol 2003(54):579–616

    Article  Google Scholar 

  21. Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P et al (2007) Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 30(3):320–324

    PubMed  Google Scholar 

  22. Aloia MS, Goodwin MS, Velicer WF, Arnedt JT, Zimmerman M, Skrekas J et al (2008) Time series analysis of treatment adherence patterns in individuals with obstructive sleep apnea. Ann Behav Med 36(1):44–53

    Article  PubMed  Google Scholar 

  23. Rechtschaffen A, Kales A, eds. A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. Brain Research Institute, UCLA, Los Angeles, CA; 1973.

  24. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    PubMed  CAS  Google Scholar 

  25. Weaver TE, Maislin G, Dinges DF, Younger J, Cantor C, McCloskey S et al (2003) Self-efficacy in sleep apnea: instrument development and patient perceptions of obstructive sleep apnea risk, treatment benefit, and volition to use continuous positive airway pressure. Sleep 26(6):727–732

    PubMed  Google Scholar 

  26. Watson D, Clark LA, Tellegen A (1988) Development and validation of brief measures of positive and negative affect: The PANAS scales. J Pers Soc Psychol 54(6):1063–1070

    Article  PubMed  CAS  Google Scholar 

  27. Raudenbush SW, Bryk AS, Congdon R. Hierarchical Linear Modeling 6.04 ed. Scientific Software International, Lincolnwood, IL; 2007.

  28. Kreft IGG, de Leeuw J, Aiken LS (1995) The effect of different forms of centering in hierarchical linear models. Multivariate Behav Res 30(1):1–21

    Article  Google Scholar 

  29. Bryk AS, Raudenbush SW (1992) Hierarchical linear models: applications and data analysis methods. Sage, Newbury Park

    Google Scholar 

  30. Kribbs NB, Pack AI, Kline LR, Getsy JE, Schuett JS, Henry JN et al (1993) Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis 147(5):1162–1168

    PubMed  CAS  Google Scholar 

  31. Santamaria J, Iranzo A, Ma Montserrat J, de Pablo J (2007) Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. Sleep Med Rev 11(3):195–207

    Article  PubMed  Google Scholar 

  32. Joo EY, Woo ST, Lee MJ, Kang JW, Park HS, Lee JY et al (2010) Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. Sleep 33(2):235–241

    PubMed  Google Scholar 

  33. Aloia MS, Di Dio L, Ilniczky N, Perlis ML, Greenblatt DW, Giles DE (2001) Improving compliance with nasal CPAP and vigilance in older adults with OAHS. Sleep Breath 5(1):13–21

    Article  PubMed  CAS  Google Scholar 

  34. Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR (2007) Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep 30(5):635–640

    PubMed  Google Scholar 

  35. Stepnowsky CJ Jr, Palau JJ, Gifford AL, Ancoli-Israel S (2007) A self-management approach to improving continuous positive airway pressure adherence and outcomes. Behav Sleep Med 5(2):131–146

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was funded in part by an APA Division 38 Health Psychology graduate student research award and by the University of Utah Sleep Wake Center. The authors thank the physicians and staff at the University of Utah Sleep wake center for their assistance in data collection, including Dr. Robert Simpson, Rick Pointer and Thi-ly Downing.

Author information

Authors and Affiliations

  1. Department of Neurology, Feinberg School of Medicine, Northwestern University, 710 N. Lake Shore Drive, 5th Floor, Chicago, IL, 60611, USA

    Kelly Glazer Baron

  2. Department of Psychology, University of Utah, Salt Lake City, UT, USA

    Laura A. Czajkowski

  3. Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

    Cynthia A. Berg, Timothy W. Smith & Heather E. Gunn

  4. Department of Neurology, University of Utah, Salt Lake City, UT, USA

    Christopher R. Jones

Authors
  1. Kelly Glazer Baron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia A. Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura A. Czajkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timothy W. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heather E. Gunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christopher R. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kelly Glazer Baron.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baron, K.G., Berg, C.A., Czajkowski, L.A. et al. Self-efficacy contributes to individual differences in subjective improvements using CPAP. Sleep Breath 15, 599–606 (2011). https://doi.org/10.1007/s11325-010-0409-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-010-0409-5

Keywords

Search

Navigation