A Tailored Intervention for PAP Adherence: The SCIP-PA Trial

ABSTRACT

Objective/Background: Positive airway pressure (PAP) is highly efficacious treatment but nonadherence is prevalent with little improvement over the last 15 years. Tailored interventions show promise for promoting adherence to other treatments. The study objective was to examine feasibility and acceptability of a tailored intervention to promote PAP adherence. Participants: The convenience sample met inclusion criteria: newly diagnosed OSA; treatment-naïve; ≥ 18 years. Exclusion criteria: previous obstructive sleep apnea (OSA) diagnosis and treatment; new psychiatric diagnosis; use of oxygen/bilevel PAP; secondary sleep disorder. Adults (n = 118) were randomized to tailored intervention (TI; n = 61) or usual care (UC; n = 57); application of a priori exclusion criteria resulted in 30 participants per assignment who were middle-aged (51.3 ± 11.1 years) adults (70% male) with severe OSA (apnea hypopnea index [AHI], 35.9 ± 25.2). Methods: Randomized, double-blind, single-site pilot controlled trial. A multiphased tailored intervention targeting social cognitive perceptions of OSA–PAP treatment was delivered at four intervals. Descriptive analysis, group differences, and self-efficacy change scores by t-test, and thematic analysis of acceptability data are reported. Results: One-week PAP use among TI was 35 min greater than UC condition (p = 0.20; Cohen’s d = 0.336). Treatment use decreased at 1 month and 3 months (NS). Per-protocol delivery of face-to-face intervention delivery was 100% but lower for telephone intervention delivery. Personalized approach was valued by participants. Conclusions: A tailored intervention approach is acceptable to participants and feasibly implemented in a clinical sleep center setting. The intervention effect size at 1 week is consistent with other educational PAP adherence interventions but was not sustained; further pilot testing is warranted to address pilot RCT limitations.

ACKNOWLEDGMENTS

The investigators acknowledge the staff and providers at the Penn State Hershey Medical Center Sleep Center for their assistance and support during participant recruitment and conduct of the research.

FUNDING

The project described was supported by award number R00NR011173 (Amy M. Sawyer, PI) from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. The reported research was also supported by American Nurses Foundation and Sigma Theta Tau International (Amy M. Sawyer, PI) and the American Sleep Apnea Association (sleep apnea educational materials). None of the funding sources contributed to study design, data collection, analysis and interpretation of the data, or dissemination of the study results.

Additional information

Funding

The project described was supported by award number R00NR011173 (Amy M. Sawyer, PI) from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. The reported research was also supported by American Nurses Foundation and Sigma Theta Tau International (Amy M. Sawyer, PI) and the American Sleep Apnea Association (sleep apnea educational materials). None of the funding sources contributed to study design, data collection, analysis and interpretation of the data, or dissemination of the study results.