Increased Adherence to CPAP With a Group Cognitive Behavioral Treatment Intervention: A Randomized Trial

STUDY OBJECTIVE: To improve adherence to continuous positive airway pressure (CPAP) treatment in participants with obstructive sleep apnea (OSA) using a cognitive behavioral therapy (CBT) intervention. DESIGN: A randomized controlled trial. SETTING: A major teaching hospital in Sydney (2005). PARTICIPANTS: One hundred individuals (96 men), ranging in age from 32 to 81 years, diagnosed with OSA. INTERVENTION: Two 1-hour CBT interventions (including a video of real CPAP users) plus treatment as usual (mask fitting and information) or treatment as usual only. MEASUREMENTS AND RESULTS: Hours of CPAP usage was assessed at 7 nights and 28 nights. Adherence was defined as usage at least 4 hours per night. Questionnaires measuring self-efficacy, social support, and expectancy (mediators of adherence) were given after intervention or after usual treatment. A higher adherence to CPAP therapy was found in the CBT group (2.9 hours difference) relative to treatment as usual (P < 0.001) at 28 days. Only 4 participants in the CBT group did not initiate treatments after their titration study, compared with 15 in the treatment as usual group (P < 0.02). The CBT group had significantly higher scores for self-efficacy (P < 0.001) and social support P < 0.008) but not for expectancy. CONCLUSIONS: The CBT intervention resulted in both increased adherence and "uptake" of CPAP and therefore would be expected to reduce the social, economic, and health-related consequences of untreated OSA.