Adult Perceptions of the Diagnosis and Treatment of Obstructive Sleep Apnea

Adult perceptions of the diagnosis and treatment of Obstructive Sleep Apnea: The influence of patients’ experiences and beliefs on CPAP adherence outcomes Amy M. Sawyer, Ph.D., R.N., 1,2,3 Terri E. Weaver, Ph.D., R.N., 1,2 Janet A. Deatrick, Ph.D., R.N., 4 Samuel T. Kuna, M.D. 2,3 1 Biobehavioral and Health Sciences Division, School of Nursing; 2 Center for Sleep & Respiratory Neurobiology, School of Medicine; University of Pennsylvania; 3 Philadelphia Veterans Affairs Medical Center; 4 Center for Health Disparities Research, School of Nursing, University of Pennsylvania; Philadelphia, Pennsylvania, U.S.A. Typology of CPAP Adherers and Nonadherers ,[object Object],[object Object],Study Aims ,[object Object],[object Object],Theoretical Framework The purpose of the study was to describe differences in obstructive sleep apnea (OSA) patients’ beliefs and perceptions about OSA, continuous positive airway pressure (CPAP) treatment, and self-efficacy to identify typologies of CPAP users in terms of adherence to treatment. A mixed methods, predominantly qualitative design with an embedded quantitative data collection procedure (one-week CPAP adherence) was used. Themes were derived from 30 individual interviews, conducted post-diagnosis (15) and after one week of CPAP treatment (15) using directed content analysis followed by categorization of participants as adherent/nonadherent to CPAP. Across-case analysis identified differences in beliefs and experiences between adherers and nonadherers and African American and Caucasian OSA participants. Our exploratory work identified differences in beliefs and perceptions among OSA patients, suggesting the multi-factorial and individual nature of adherence to CPAP. The newly-identified typologies of CPAP users provide critical insight for culturally-sensitive, tailored interventions to promote CPAP adherence. Study support: NIH F31-NR-009315-03 (Sawyer, PI) Abstract ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Results ,[object Object],[object Object],[object Object],[object Object],Conclusions Salient Factors Influence CPAP Adherence Decisions: Categories, Latent Meaning and Quotes Coding Categories Latent Meaning Quotes Knowledge Fears Health risks Justifying symptoms Impact of OSA on QOL/social relationships Health information applicability “ I knew sleep apnea existed but it never dawned on me how serious it was in my case. I figured I was just going to snore the rest of my life.” “ I stop breathing 90 times/hour – that scared me because I could die in my sleep.” “ Then I learned about driving being tired. I remembered that I have to pull over and nap every time we take a long trip. I figured maybe I do have sleep apnea.” Facilitators & Barriers Social influences Symptom impact on others Commonality of symptoms Shared experiences with CPAP “ I see the difference. People see the difference. My wife sees the difference. My kids see the difference. That helps because you have feedback like you know its [CPAP] working.” “ Since I’ve had the sleep machine, communication and our relationship are better; we talk more and enjoy each other more. . . I really like what it’s [CPAP] doing.” “ He told me it changed his life, that he can’t do without it, he became a totally different person now that he rests at nighttime. He pumped me up a lot” [to use CPAP]. Perceived Self-efficacy Early response to CPAP Early experience with CPAP Fitting treatment into life Problem-solving experiences “… they put the mask on me and when they came back in the room I felt great when I woke up at 6a.m.; they had to wake me up because I was sleeping…I didn’t care what it was if I got that much sleep I was going to wear or do whatever I had to do to do it [wear CPAP]” “ I was believing it was gonna do something more than what it did and it didn’t do anything…I’m still getting up tired…No, just a bunch of ‘botheration’ and I didn’t get any sleep… Outcome Expectations & Goals Symptoms associated with diagnosis Early response to CPAP Problem-solving ability “… the first night I put it on I got a little claustrophobia but I pushed it out of my mind saying ‘don’t let this bother you, this machine is going to help you, you got to wear it.” “ The first couple of nights I worried too much. Now I found it the way I feel comfortable and I can sleep, I just leave it that way every night now.” Adherent CPAP User Nonadherent CPAP User Define risks associated with OSA Unable to define risks associated with OSA Identify outcome expectations from outset of diagnosis Describe few outcome expectations Have fewer barriers than facilitators Describe barriers as more influential on CPAP use than facilitators Develop and define goals and reasons for CPAP use Facilitators of treatment absent or unrecognized Describe positive belief in ability to use CPAP even with potential or experienced difficulties Describe low belief in ability to use CPAP Proximate social influences prominent in decisions to pursue diagnosis and treatment Describe early negative experiences with CPAP, reinforcing low belief in ability to use CPAP Unable to identify positive responses to CPAP during early treatment

Adult Perceptions of the Diagnosis and Treatment of Obstructive Sleep Apnea

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Adult Perceptions of the Diagnosis and Treatment of Obstructive Sleep Apnea