Megan Brooks

June 03, 2013

Baltimore, Maryland — Having a regular bedtime may boost adherence to continuous positive airway pressure (CPAP) therapy, new research hints.

"Our study is the first to identify that regularity of bedtime, prior to CPAP treatment, is an important factor that influences adults' consistent use of CPAP," principal investigator Amy M. Sawyer, PhD, RN, assistant professor, Pennsylvania State University School of Nursing, University Park, told Medscape Medical News.

"Our results, not previously reported, suggest that CPAP use is associated with stable bedtime schedules; by stabilizing bedtime schedules or promoting consistency in bedtime patterns and routines prior to initiating CPAP treatment, CPAP use (ie, adherence) may improve," Dr. Sawyer said.

She will present the study findings June 5 at the SLEEP 2013: Associated Professional Sleep Societies 27th Annual Meeting.

Novel Observation

"This study is important because CPAP compliance is so important," William C. Kohler, MD, member of the American Academy of Sleep Medicine and medical director of the Florida Sleep Institute in Spring Hill, who was not involved in the study, told Medscape Medical News.

"CPAP is the main treatment for obstructive sleep apnea and if you just give the patient the machine and they don't use it, it doesn't do any good. Compliance is a problem and anything that we can do to improve compliance would be very beneficial," Dr. Kohler said.

In this study, Dr. Sawyer and colleagues aimed to determine whether variability of sleep schedule or pre-CPAP bedtime was different among CPAP adherers and nonadherers and if that influenced CPAP adherence.

They studied 97 predominantly male obese adults with newly diagnosed obstructive sleep apnea (OSA), with apnea-hypopnea index of at least 10 events/hour). CPAP adherence was defined as 4 hours per night, which is the common clinical and third-party payer definition, Dr. Sawyer said.

The study team found that variability in bedtime was a significant predictor of CPAP adherence at 1 month, with adherers having less inconsistency in their bedtime than nonadherers (49.4 vs 66.7 minutes; P = .02).

After 1 month, the likelihood of using CPAP for less than 4 hours per night was 3.7 (95% confidence interval [CI], 1.25 - 10.83) times greater for every increment of bedtime variability, or with increasing inconsistency of pretreatment bedtime.

Dr. Sawyer said a "clinically relevant question" is how much variability in bedtime is important to adherence outcomes. "We identified that the odds of nonadherence was 3.2 times greater for those whose bedtime varied by 75 minutes or more (P = .03). Furthermore, the odds of nonadherence were 1.8 times greater for every 30 minute increase in bedtime variability (P = .04)."

"Actionable" Findings

It's conservatively estimated that 5% of US adults have OSA, "with far greater incidence among overweight and obese adults," Dr. Sawyer noted. Untreated OSA contributes to significant morbidity and mortality; productivity and quality of life impairments in untreated OSA result from excessive daytime sleepiness, mood and psychological impairments, and cognitive dysfunction, she pointed out.

Nonadherence to CPAP is well recognized as a limitation of treating OSA, with approximately 50% of CPAP-treated adults identified as nonadherent to CPAP, she added. "We are very pleased to discover a potential intervention target for the promotion of CPAP use in adults newly initiated on CPAP therapy," Dr. Sawyer said.

"In this study, decreasing the variability in going to bed and getting up clearly improved adherence. This is something we can tell our patients," Dr. Kohler told Medscape Medical News.

The study was supported by a research grant by National Institutes of Health/ National Institute for Nursing Research. The authors and Dr. Kohler have disclosed no relevant financial relationships.

SLEEP 2013: Associated Professional Sleep Societies 27th Annual Meeting. Abstract: 0511. Presented June 5, 2013.

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