Personalized and Patient-Centered Strategies to Improve Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea

Figures & data

Table 1 Positive Airway Pressure (PAP) Adherence Interventions

Intervention Strategy	Types of Interventions	Mean Difference (MD) in PAP Use, by Meta-Analysis	Endpoints
Educational	Written materials, watching a video, face-to-face didactic sessions	MD 0.55 hrs/night higher (95% CI=0.04, 1.06) 638 participants (7 RCTs)^Citation24	1 mo–1 yr^Citation24
		MD 0.85 hrs/night higher (95% CI=0.32, 1.39) 1128 participants (10 RCTs)^Citation28	3 mos^Citation28
Behavioral	Motivational enhancement, cognitive behavioral therapy, stage matched intervention	MD 1.15 hrs/night higher (95% CI= 0.27, 2.04) 517 participants (6 RCTs)^Citation24	1 mo–1 yr^Citation24
		MD 1.31 hrs/night higher (95% CI=0.95, 1.66) 578 participants (8 RCTs)^Citation28	3 mos^Citation28
Supportive	Troubleshooting/ practical support (home visits, phone calls from medical or non-medical personnel, automated phone calls, and inquiries via computer)	MD 0.66 hrs/night higher (95% CI=0.19, 1.13) 670 participants (9 RCTs)^Citation24	1 mo–1 yr^Citation24
		MD 0.70 hrs/night higher (95% CI=0.36, 1.05) 1426 participants (13 RCTs)^Citation28	3 mos^Citation28
Technological	Intervention delivered via telephone calls, telemedicine (eg, videoconferencing), websites, smartphone applications, texting Telemonitoring	MD 0.54 hrs/night (95% CI=0.29, 0.79) 5429 participants (18 RCTs)^Citation45	1 mo–6 mos^Citation45
		MD 0.98 hrs/night (95% CI=0.53, 1.42) 498 participants (5 RCTs)^Citation24	1 mo–1 yr^Citation24

Note: hrs, hours; mo(s), month(s); RCT, randomized controlled trial; yr, year.

Table 2 Individualized Health Care Approaches and Applications

	Approach	Definition	Example for OSA/PAP Care
Individualized healthcare	Personalized medicine	Using an individual’s clinical history and biological characteristics to tailor therapies to that person.^Citation68	Tailoring care/treatment by:  ● Treating insomnia (for a patient with an insomnia phenotype of OSA).^Citation75^–^Citation77  ● Examining clinical history for cardiovascular disease or poorly managed hypertension, despite antihypertensive regimen.
	Patient-centered care	Generally, refers to communication and interactions in clinical visits. Centers around the management of disease with patients’ preferences prioritized.^Citation72	Prioritizing the patient by:  ● Using a shared decision-making tool and varying treatment plan based on patient preferences, such as negotiating hours/days or days/week of PAP use, based on work or weekend schedule  ● Discussing a treatment plan that “works for them”, based on sleep habits or preferred sleeping environment  ● Using visit satisfaction surveys  ● Personalizing patient education based on individual risks (eg, multiple chronic conditions)
	Person-centered care	Generally, views diseases as interrelated phenomena and considers the evolution of individuals experienced health problems and diseases over time. A focus on individuals right to self-determination and ideally involves a long-standing relationship between provider and patient for a more holistic view.^Citation72	Treating the whole person by:  ● Creating care teams so patients regularly interact with the same providers and staff  ● Developing case management approaches wherein a point of contact is assigned and that contact works across interdisciplinary teams (eg, primary care, sleep, cardiology) to coordinate care for the individual

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