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New research helps overcome major CPAP problem

For the first time, a group based cognitive behavioural therapy (CBT) intervention has been demonstrated to markedly increase acceptance and adherence to CPAP treatment for sufferers of obstructive sleep apnea (OSA).

The results of the Australian based study, published this month in the international publication Sleep, found at one month 77% of participants exposed to the intervention used CPAP for a least four hours a night, compared with 31% in the treatment as usual group.

The findings present major positive health implications for sufferers of OSA, with CPAP recognised as a highly efficient treatment for sleep apnea yet low in effectiveness due to reluctance by sufferers to use the device.

The Woolcock Institute of Medical Research successfully conducted the trial in Sydney. One hundred participants were randomly assigned to either a treatment as usual (TAU) group or to the CBT group.

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The intervention required participants to attend two one-hour sessions in addition to the usual treatment. It included a 15-minute video presentation featuring real-life CPAP users who described their personal experiences of learning to manage CPAP. The key message was the need to persevere with the treatment and ask for help from the sleep unit staff because of the long-term health benefits. A booklet featuring the same role models accompanied this.

Dr Delwyn Bartlett, Sleep Psychologist at the Woolcock Institute of Medical Research, explains the intervention was designed to help individuals not only understand the risks of OSA but more importantly to see the future benefits of CPAP treatment.

"The results are extremely encouraging, particularly as some or most of this intervention enabled individuals to use CPAP on a nightly basis which is a primary goal of treatment," she said.

"Our CBT intervention was fairly simple and relatively inexpensive as it was administered in a group setting. Yet it resulted in marked improvement in CPAP adherence and use compared with standard care."

Dr Bartlett said importantly the study also found only 8% of participants in the CBT group refused CPAP either before or after the titration period as compared to 30% in treatment as usual group.

"We believe that the instigation of a CBT program immediately following referral for CPAP will help keep participants engaged in a treatment process that will transform their health."

The American Academy of Sleep Medicine will publish the Woolcock Institute paper in the May 2007 issue of Sleep.