Correct!
2. Cognitive behavioral therapy


Obstructive sleep apnea (OSA) is associated with several adverse outcomes (1,2). Adherence to continuous positive airway pressure (CPAP) therapy is a key to improving outcomes in patients with OSA. Adherence to CPAP is commonly (and empirically) defined as use of CPAP machine for ≥4 hour every night, ≥70% of the nights, However, data support that more hours of use of CPAP every night result in better clinical outcomes (3).
Studies suggest that pattern of adherence to CPAP is developed as early as 3 days after the initiation of the therapy (4). The use of newer PAP devices including autoPAP (5,6), severity of OSA on diagnostic polysomnography or ESS score at initiation of PAP therapy have not been consistently shown to predict adherence to CPAP therapy.

Cognitive behavioral therapy (CBT) is a useful intervention to improve CPAP adherence (7).  A Cochrane review concluded that educational and behavioral interventions can increase average CPAP use by almost 3 hours at night, and found a number need to treat of 3 patients for one additional person to increase machine use to 6 or more hours a night (8). Telephone linked communication and eszopiclone treatment for 2 weeks at the beginning of CPAP therapy have also shown significant positive effect on CPAP adherence (9). Finally, use of heated humidification has been suggested to improve adherence in small studies, and is recommended in American Academy of Sleep Medicine practice parameter (10).


References

  1. Budhiraja R, Budhiraja P, Quan SF. Sleep-disordered breathing and cardiovascular disorders. Respir Care 2010;55:1322-32.
  2. Flemons WW. Obstructive Sleep Apnea. N Engl J Med 2002;347:498-504.
  3. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008;5:173-8.
  4. Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P, Saunders V, Hudgel DW. Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 2007;30:320–324.
  5. Quan SF, Awad KM, Budhiraja R, Parthasarathy S. The Quest to Improve CPAP Adherence--PAP Potpourri is Still Not the Answer, but more research is needed. J Clin Sleep Med 2012;8:345.
  6. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep 2012;35:757-67.
  7. Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep 2007;30:635-40.
  8. Smith I, Nadig V, Lasserson TJ. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnea. Cochrane Database Syst Rev 2009; Apr 15.
  9. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 2011;15: 343-56.
  10. Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Boehlecke B, Brown TM, Coleman J Jr, Friedman L, Kapen S, Kapur VK, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Swick TJ, Wise MS; American Academy of Sleep Medicine. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 2006;29:375-80.

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