CPAP compliance: video education may help!

Abstract

Background: CPAP remains the treatment of choice for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), but compliance with CPAP is poor. Of many interventions tried to improve CPAP compliance, only education and humidification have been shown to be of benefit. Our purpose was to develop and pilot test a video to enhance patient understanding of obstructive sleep apnea and of the purpose, logistics, and benefits of CPAP use in patients newly diagnosed with OSAHS. A patient's CPAP compliance in the first few weeks after starting its use is predictive of long-term compliance with CPAP treatment. It is imperative that patients grasp at the outset both the severity of OSAHS and the effectiveness of CPAP therapy. Methods: An educational video script was written based on recommendations for patient educational video materials and covering identified misconceptions about OSAHS and perceived barriers to CPAP use. The videotape is 15 min in length and features two middle-aged males, one African-American and one Euro-American, discussing OSAHS and CPAP in a factory break room. Results: In a randomized two-group design with a control group, patients with newly diagnosed OSAHS, and who viewed the CPAP educational video on their first clinic, were significantly more likely to use their machine and to return for a 1-month clinic visit than were those in the control group. Conclusion:Viewing of a patient education video at the initial visit was found to significantly improve the rate of return for the follow-up visit.

Introduction

The Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) is believed to be present in the adult population ages 30–60 years in the US at a rate of 4% in men and 2% in women and even higher in minority groups and in the elderly [1], [2], [3]. Obesity is the single most important risk factor for OSAHS [4]. Therefore, given that the 65+age group is the most rapidly growing segment of the US adult population, that rates of obesity are rising, and that screening for OSAHS is becoming more common, the reported prevalence of obstructive sleep apnea can be expected to rise. The potential health consequences of sleep apnea are serious, including hypertension, cardiovascular problems, excessiveness daytime sleepiness, and cognitive deficits which contribute to social dysfunction and vehicular accidents [5], [6]. In those cases where obesity is a contributing factor, weight loss is the only ‘cure’ for OSAHS. Since its introduction in 1981, however, the standard treatment for OSAHS is continuous positive airway pressure (CPAP) [7].

Compliance with this treatment is estimated in the US to be between 29 and 89% [8]. This is a compliance rate better than that for regimens of many other chronic conditions, but is surprisingly low since regular CPAP use has consistently demonstrated significant improvement in daytime sleepiness and general quality of life even in those patients with mild OSAHS [9], [10], [11]. Therefore, increasing compliance with CPAP is critical [12].

Improvements in CPAP technology have addressed patient complaints about the machine and mask, but the level of compliance with CPAP is still a clinically significant problem. Compliance appears to depend on the severity of the disease as well as on the initial inpatient management session. The first few weeks are critical to compliance [13], [14], [15]. An alarming finding was that many OSAHS patients mistakenly believe that CPAP use will ‘cure’ their sleep disorder, at which time they can discontinue its use [1].

Improving CPAP compliance in the US, especially among patients with mild OSAHS, rests on improved patient education because just as with other chronic conditions, hospital stays in the US are becoming shorter and less frequent. Patients, therefore, must have an accurate understanding of their condition and its treatment and be motivated to carry it out at home without medical supervision [16]. CPAP patient education research has identified several characteristics essential to a successful educational instrument. Both patients and staff prefer video format to either text or oral staff-delivered information. The video message remains standardized and can be self-administered by the patient, thus freeing staff as well as giving patients privacy. Within the video message, there is a preference for culturally appropriate actors speaking in lay vocabulary about OSAHS and addressing practical suggestions for adjusting to CPAP therapy. The running time of such a tape should be short, optimally about 8 min [17]. The specific target issues identified by literature review and patient interviews were the following: precisely what is OSAHS and what causes it? How serious is OSAHS? What is a CPAP machine? Will CPAP cure it? Will insurance pay for it? How best can one normalize CPAP use within the household? If one has problems using CPAP, how can help be obtained?

Given the recommended content and parameters, a 15-min CPAP educational videotape was developed. It features two factory workers conversing in their break room. One has just been diagnosed with OSAHS while the other has been using CPAP successfully for about 2 years. The latter delivers the educational information in the form of replies to questions by the former, all delivered in common vernacular.