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Original Research: Sleep Disorders |

Motivational Enhancement for Increasing Adherence to CPAP: A Randomized Controlled Trial

Jessie P. Bakker, PhD; Rui Wang, PhD; Jia Weng, PhD; Mark S. Aloia, PhD; Claudia Toth, PsyD; Michael G. Morrical, BA; Kevin J. Gleason, BA; Michael Rueschman, MPH; Cynthia Dorsey, PhD; Sanjay R. Patel, MD; James H. Ware, PhD; Murray A. Mittleman, MD, DrPH; Susan Redline, MD, MPH
Author and Funding Information

FUNDING/SUPPORT: This study was supported by NIH NHLBI [Grant 1U34HL105277] and a grant from ResMed Foundation. Equipment was donated by ResMed and Philips Respironics.

aDivision of Sleep & Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

bDepartment of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA

cNational Jewish Health, Denver, CO

dPhilips Respironics, Murrysville, PA

eMcLean Hospital, Harvard Medical School, Boston, MA

fDepartment of Epidemiology, Harvard TH Chan School of Public Health and Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA

CORRESPONDENCE TO: Jessie P. Bakker, PhD, 221 Longwood Ave, Ste BL257B, Boston, MA 02115


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):337-345. doi:10.1016/j.chest.2016.03.019
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Background  Motivational enhancement (ME) shows promise as a means of increasing adherence to CPAP for OSA.

Methods  We performed an open-label, parallel-arm, randomized controlled trial of CPAP only or CPAP + ME, recruiting individuals 45 to 75 years with moderate or severe OSA without marked sleepiness and with either established cardiovascular disease (CVD) or at risk for CVD. All participants received standardized CPAP support from a sleep technologist; those randomly assigned to CPAP + ME also received standardized ME delivered by a psychologist during two appointments and six phone calls over 32 weeks. Mixed-effect models with subject-specific intercepts and slopes were fitted to compare objective CPAP adherence between arms, adjusting for follow-up duration, randomization factors, and device manufacturer. All analyses were intention-to-treat.

Results  Overall, 83 participants (n = 42 CPAP only; n = 41 CPAP + ME) contributed 14,273 nights of data for 6 months. Participants were predominantly male (67%) and had a mean ± SD age of 63.9 ± 7.4 years, a BMI of 31.1 ± 5.2 kg/m2, and an apnea-hypopnea index of 26.2 ± 12.9 events/h. In our fully adjusted model, average nightly adherence for 6 months was 99.0 min/night higher with CPAP + ME compared with CPAP only (P = .003; primary analysis). A subset of 52 participants remained in the study for 12 months; modeling these data yielded a consistent difference in adherence between arms of 97 min/night (P = .006) favoring CPAP + ME.

Conclusions  ME delivered during brief appointments and phone calls resulted in a clinically significant increase in CPAP adherence. This strategy may represent a feasible approach for optimizing management of OSA.

Trial Registry  ClinicalTrials.gov; No.: NCT01261390; URL: www.clinicaltrials.gov.

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