Risk Assessment and Tailored Intervention to Improve CPAP Adherence

Poor adherence to CPAP is a significant problem among OSA patients resulting in suboptimal health and functional outcomes. Although few in number, studies that have tested interventions to improve CPAP adherence have shown relatively small effects in selected samples and were costly. No published studies to date have specifically focused on those persons at high risk for nonadherence to CPAP or applied a tailored inten/ention strategy to promote CPAP adherence. The overall objective of the proposed research is to examine the effect, feasibility, and acceptability of a tailored intervention on CPAP adherence among OSA patients at risk for CPAP nonadherence. The proposed study will enroll high risk CPAP nonadherers, identified pre-treatment, in a pilot randomized control trial with participants randomly assigned to a tailored intervention or usual care (control). The investigator-developed tailored intervention is based on tenets of Social Cognitive Theory and focuses on enhanced patient education, CPAP skill-building, promotion of early positive experiences with CPAP, establishing early accurate and personalized cognitive perceptions of OSA and CPAP, and inclusion of proximate social support resources. The central hypothesis is that critically timed tailored interventions that focus on sociocultural aspects and cognitive perceptions of the individual experience with OSA diagnosis and treatment will improve overall CPAP adherence rates among those likely to demonstrate suboptimal use of the treatment. The specific aims are: (1) to determine the effect size of a tailored intervention on CPAP adherence outcomes at 1 week, 1 month, and 3 months among OSA patients, identified pre-treatment, as high risk for subsequent nonadherence; and (2) to determine the feasibility and acceptability of the tailored intervention which will guide intervention refinement for a subsequent R01 application. These preliminary data will support the design and successful conduct of a larger randomized controlled trial testing the overall effectiveness of the tailored intervention.