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  • Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial

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Sleep
Original article
Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial
  1. Amy S Guralnick1,
  2. Jay S Balachandran1,
  3. Shane Szutenbach1,
  4. Kevin Adley1,
  5. Leila Emami1,
  6. Meelad Mohammadi1,
  7. Jeanne M Farnan2,
  8. Vineet M Arora2,
  9. Babak Mokhlesi1
  1. 1 Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA
  2. 2 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Babak Mokhlesi, Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, MC6076/Room M630, Chicago, IL 60637-1470, USA; bmokhles{at}medicine.bsd.uchicago.edu

Abstract

Background Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence.

Methods Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date.

Results A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic.

Conclusions In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care.

Trial registration number ClinicalTrials.gov Identifier: NCT02553694.

  • compliance
  • auto-PAP
  • sleep apnea
  • clinic show rate

https://doi.org/10.1136/thoraxjnl-2017-210106

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    Footnotes

    • ASG and JSB contributed equally.

    • Contributors JSB, BM, ASG and VMA designed the study. SS, KA, LE and MM collected data. BM, ASG, JSB, VMA and JMF participated in data management, analyses, interpretation and manuscript preparation. BM oversaw all analyses and takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript. All authors approved this manuscript in its final form.

    • Competing interests ASG, JSB, SS, KA, LE, MM and JMF have no conflicts of interest to declare. VMA, JMF and BM receive support from the National Institutes of Health Grant R25HL116372-03. BM is supported in part by the National Institutes of Health Grant R01HL119161. He has also received honorarium from Zephyr Medical Technologies and has served on the advisory board of Itamar Medical. None of the competing interests are related to the content of the submitted research.

    • Ethics approval University of Chicago’s Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.