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Predicting uptake of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnoea (OSA): a belief-based theoretical approach

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Abstract

Purpose

Obstructive sleep apnoea (OSA) is a common disorder, for which continuous positive airway pressure (CPAP) therapy is a standard treatment. Despite its well-established efficacy, many patients choose not to initiate CPAP treatment. The present study investigated the degree to which biological measures (e.g. Apnoea–Hypopnoea Index [AHI]), symptom experiences (e.g. fatigue) and illness representations (e.g. perceived consequences) predict the decision of individuals newly diagnosed with OSA to undergo a trial of CPAP therapy.

Methods

Four hundred forty-nine individuals (316 males) newly diagnosed with OSA. Epworth sleepiness scale (ESS), Fatigue Severity Scale, Depression Anxiety Stress Scale and Illness Perception Questionnaire-Revised (IPQ-R) were administered at time of sleep study. These, patient demographics and sleep study variables were used to determine factors predicting patient decision to proceed with a trial of CPAP.

Results

The participants were most likely to attribute their OSA to unchangeable and psychological factors. For those with moderate OSA (AHI, 15 to 30) IPQ-R illness consequence was predictive of decision to initiate CPAP (p = 0.002). For severe OSA (AHI >30) age, ESS and IPQ illness causal beliefs were predictive of decision to initiate CPAP (p < 0.001).

Conclusions

Illness beliefs are important determinants of the choice of recently diagnosed OSA patients whether or not to undertake a trial of CPAP therapy. Concerns about illness consequences were important in those with moderate OSA. In severe OSA, sleepiness symptoms are more prominent and a more significant determinant of CPAP uptake along with age and causal beliefs.

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Acknowledgments

This report would not have been possible without the essential and gracious support of many individuals: Christine Maguire and the sleep technologists of SCGH, as well as the students of UWA, Alisa Holt, Anna Wallace, Stephanie Whitworth, Alix Mellor, Andrew Nienaber, Jacinta Hatton and Shraddha Kashyup.

Conflicts of interest

Two of the authors (D. Hillman and P. Eastwood) are members of Apnex Medical Incorporated as consultants and as part of the medical advisory board.

Disclosures

No external financial support was provided for this project.

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Authors and Affiliations

  1. Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia

    Timothy Skinner

  2. School of Psychology, Faculty of Life and Physical Sciences, University of Western Australia, Perth, Australia

    Lindsay McNeil, Michelle Olaithe, Janet Phang, Tamara de Regt & Romola S. Bucks

  3. Child and Adolescent (Mental) Health Services, Princess Margaret Hospital, Perth, Western Australia, Australia

    Lindsay McNeil

  4. Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth, Western Australia, Australia

    Peter Eastwood

  5. Department of Pulmonary Physiology and Sleep Medicine, Western Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia

    Peter Eastwood & David Hillman

  6. Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Tamara de Regt

  7. Singapore General Hospital, Singapore, Singapore

    Janet Phang

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  1. Timothy Skinner
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  2. Lindsay McNeil
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  3. Michelle Olaithe
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  8. Romola S. Bucks
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Correspondence to Timothy Skinner.

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The work was performed at institutions 1, 2 and 3.

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Skinner, T., McNeil, L., Olaithe, M. et al. Predicting uptake of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnoea (OSA): a belief-based theoretical approach. Sleep Breath 17, 1229–1240 (2013). https://doi.org/10.1007/s11325-013-0828-1

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  • DOI: https://doi.org/10.1007/s11325-013-0828-1

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