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Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
Department of Nursing, School of Health Sciences, Jönköping University College, Jönköping, Sweden.
Department of Nursing, School of Health Sciences, Jönköping University College, Jönköping, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
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2014 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, no 4, 799-807 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: Continuous Positive Airway Pressure is an effective treatment for obstructive sleep apnea, but adherence is often low and side effects are common. It is unclear from previous research whether side effects are significant causes of non-adherence. No study has examined if side effects vary within subjects over time. The aims were to 1) examine the evolution of CPAP side effects over time; and 2) prospectively assess correlations  between early CPAP side effects and treatment adherence. Methods: 186 obstructive sleep apnea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time. Results: The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within one year in approximately 30% of patients who had not experienced them after two weeks. Increased number of awakenings and dry mouth after 1-2 weeks were significantly associated to treatment dropout during the first year and machine usage time after six months. Conclusions: While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.

Place, publisher, year, edition, pages
Springer, 2014. Vol. 18, no 4, 799-807 p.
Keyword [en]
Obstructive sleep apnea/adverse effects, Continuous positive airway pressure, Adherence, Side Effects to CPAP Inventory
National Category
Medical and Health Sciences Nursing
Identifiers
URN: urn:nbn:se:liu:diva-97474DOI: 10.1007/s11325-014-0945-5ISI: 000344784800018PubMedID: 24557772OAI: oai:DiVA.org:liu-97474DiVA: diva2:647944
Available from: 2013-09-13 Created: 2013-09-13 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Psychometric aspects of obstructive sleep apnea syndrome
Open this publication in new window or tab >>Psychometric aspects of obstructive sleep apnea syndrome
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder consisting of episodes with impaired breathing due to obstruction of the upper airways. Treatment with Continuous Positive Airway Pressure (CPAP) is a potentially effective treatment, but adherence is low. Several potential factors affecting adherence, e.g., subjective sleepiness and personality, are only quantifiable through questionnaires. Better knowledge about psychometric properties of such questionnaires might improve future research on CPAP adherence and thus lead to better treatment options.

Aim: Study I: To describe the devlopment and initial testing of the Side Effects of CPAP treatment Inventory (SECI) questionnaire. Study II: To describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. Study III: To study whether any of the items in the Epworth Sleepiness Scale (ESS) exhibit differential item functioning and, if so, to which degree. Study IV: To examine the evolution of CPAP side effects over time; and prospectively assess correlations between early CPAP side effects and treatment adherence.

Patients and Methods: In study I, SECI items were based on a literature review, an expert panel and interviews with patients. It was then mailed to 329 CPAP-treated OSAS patients. Based on this, a principal component analysis was performed, and SECI results were compared between adherent and non-adherent patients. In study II, the population consisted of 247 OSAS patients with ongoing CPAP treatment. The DS14 was used to assess the prevalence of type D personality, and SECI and adherence data from medical records were used to correlate Type D personality to side effects and adherence. In study III, the population consisted of pooled data from 1,167 subjects who had completed the ESS in five other studies. Ordinal regression and Rasch analysis were used to assess the existence of differential item functioning for age and gender. The cutoff for age was 65 years in the Rasch analysis. In study IV, SECI was sent to 186 subjects with newly diagnosed OSAS three times during the first year on CPAP. SECI results were followed over time within subjects, and were correlated to treatment dropout during the first year and machine usage time after 6 months.

Results: SECI provides a valid and reliable instrument to measure side effects, and non-adherent patients have higher scores (i.e., were more bothered by side effects) than adherent patients (study I). Type D personality was prevalent in approximately 30 % of CPAP treated OSAS patients, and was associated to poorer objective and subjective adherence as well as more side effects (study II). Differential item functioning was present in items 3, 4 and 8 for age in both DIF analyses, and to gender in item 8 the Rasch analysis (study III). Dry mouth and increased number of awakenings were consistently associated to poorer adherence in CPAP treated patients. Side effects both emerged and resolved over time (study IV).

Conclusions: Differences in previous research regarding side effects and CPAP adherence might be explained by differences in how side effects and adherence are defined. While some side effects are related to adherence, others are not. Side effects are furthermore not stable over time, and might be related to personality. ESS scores are also related to CPAP adherence according to previous research, but might be affected by other factors than sleepiness, such as age and possibly gender.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 102 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1378
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97475 (URN)978-91-7519-528-5 (ISBN)
Public defence
2013-10-04, Victoriasalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
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Available from: 2013-09-13 Created: 2013-09-13 Last updated: 2013-09-13Bibliographically approved

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Ulander, MartinSvanborg, EvaBroström, Anders

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