Perceived informational needs, side-effects and their consequences on adherence—A comparison between CPAP treated patients with OSAS and healthcare personnel

doi:10.1016/j.pec.2008.08.012

Patient Education and Counseling

Volume 74, Issue 2, February 2009, Pages 228-235

https://doi.org/10.1016/j.pec.2008.08.012 Get rights and content

Abstract

Objective

To compare perceptions among continuous positive airway pressure (CPAP) treated patients with obstructive sleep apnoea syndrome (OSAS) and healthcare personnel with regard to informational needs, side-effects and their consequences on adherence.

Methods

A cross-sectional descriptive design was used including 350 CPAP treated OSAS patients from three Swedish hospitals and 105 healthcare personnel from 26 Swedish hospitals. Data collection was performed using two questionnaires covering informational needs, side-effects and adherence to CPAP.

Results

Both groups perceived all surveyed informational areas as very important. Patients perceived the possibilities to learn as significantly greater in all areas (p < 0.001) compared to healthcare personnel, and scored significantly higher regarding positive effects on adherence of information about pathophysiology (p < 0.05), self-care (p < 0.001) and troubleshooting (p < 0.01). A total of 11 out of 15 surveyed side-effects were perceived to be more frequent by healthcare personnel (p < 0.01–p < 0.001). They also scored all side-effects to cause greater problems and decrease the CPAP use to a greater extent (p < 0.001).

Conclusion

Knowledge about these differences between patients and healthcare personnel regarding educational needs, side-effects and their effects on adherence can be important when designing educational programmes to increase CPAP adherence.

Practice implications

Measurement of these parameters before, during and after educational programs are suggested.

Introduction

Obstructive Sleep Apnea (OSA) is a condition consisting of repetitive episodic disturbances of breathing during sleep, due to a complete or partial obstruction of the upper airways [1]. The disturbed breathing might lead to fragmented sleep, in turn causing nocturnal [2] as well as daytime [3] symptoms. The prevalence of OSA is estimated to lie between 3% and 28%, the large variance explained by differences in diagnostic approaches and definitions of OSA [4], [5]. The severity of the disorder is expressed as the number of total and/or partial events of respiratory obstruction per hour of sleep (AHI) and the number of oxygen desaturation events per hour of sleep (ODI). The combination of OSA and daytime symptoms is referred to as OSA syndrome (OSAS) [1]. Longstanding untreated OSAS may lead to detrimental health consequences [6], [7], [8]. The treatment of choice is continuous positive airway pressure (CPAP). CPAP creates a continuous positive air pressure via a mask that opens up the upper airways, allowing the patient to breathe freely. CPAP treatment has been found to reduce several of the risk factors associated with OSAS and daytime symptoms, as well as to increase quality of life [9], [10].

Defining adherence to CPAP can be difficult, since the necessary frequency of usage and number of hours of usage per night to attain and preserve a therapeutic effect is unknown [11]. A cut-off level of at least 4 h use per night has commonly been used [12]. To gain an optimal effect of the CPAP it is crucial to use it the whole time in bed [13]. Side-effects are common and cause high early dropout rates and low long-term adherence [14], [15], why implementing interventions based on patient education are important [11], [15]. Patient education can, from a general perspective, be defined as the process of improving knowledge and skills in order to influence the attitudes and behaviour required to maintain or improve health [16]. No generally accepted guideline for education of CPAP treated patients exists today neither from a topical or didactical aspect.

People tend to learn things that they perceive as important [17]. No studies have however, been performed where perceptions of educational needs among CPAP patients have been compared to the perceptions of healthcare personnel. Comparisons of patients and nurses have been done on patients with angina pectoris [18], myocardial infarction [19], congestive heart failure [20], cancer [21], and renal dialysis [22]. In general, the results indicated that all studied areas were perceived as important by patients as well as nurses. However, the ranking of the relative importance of different areas often differed. Cancer nurses scored information about the purpose of chemotherapy to be of relatively low importance, while patients scored it to be the area of most importance. In the same study, nurses perceived patients’ need for information about dealing with feelings as much more important than the patients did. In another study [20] patients and nurses were asked whether the learning goals were realistic. Patients tended to rate their learning abilities somewhat higher than nurses. However, perceptions of prevalence, magnitude and effect of side-effects on adherence have not, to our knowledge, been studied in healthcare personnel compared to patients in any diagnosis.

The aim of this study was therefore to compare perceptions among CPAP treated patients with OSAS and healthcare personnel with regard to informational needs, side-effects and their consequences on adherence.

Section snippets

Design and setting

This study used a cross-sectional descriptive survey design. In order to get a representative sample, patients were recruited from three different CPAP clinics (one university hospital, one provincial hospital and one private clinic) situated in one metropolitan city and two provincial cities in different parts of Sweden. Further, healthcare personnel were recruited from all 28 CPAP clinics in Swedish hospitals. The study protocol was approved by the Regional Ethics Committee for Human

Sample description

A total of 350 patients (65% men) out of 453 eligible patients (77%) answered the questionnaires. The 103 non-respondents did not differ regarding age or time after CPAP initiation. The majority of the respondents were married and had 12 or more years of education. A total of 86% of the patients used CPAP devices with fixed pressure, and 18% had a humidifier. The mean time after CPAP initiation was 55.9 months (2 weeks–182 months), and the mean time since last visit 6.5 months (2 weeks–16

Discussion

No generally accepted guidelines for education to patients before and during CPAP initiation exist today [29]. This is a limitation, since education about OSAS, CPAP and self-care activities might be factors of importance in order to increase adherence in the use of CPAP. Patients have described the need for adequate information before, during, as well as after initiation of CPAP treatment [24]. If adequate education is not given, it can cause fear, anxiety and non-adherence [25]. This raises

Acknowledgements

The authors wish to thank the Health Research Council in the South-East of Sweden for financial support, Grant FORSS-8964. We wish to thank Gerd Pihl and Maria Högquist from the Department of Clinical Neurophysiology, Linköping University Hospital, as well as Jan Albers and Anna Ståhlkrantz from the Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden, for their contributions to the study.

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Patient Perception, Preference and ParticipationPerceived informational needs, side-effects and their consequences on adherence—A comparison between CPAP treated patients with OSAS and healthcare personnel

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Design and setting

Sample description

Discussion

Acknowledgements

Sleep Med

Sleep Med Rev

Sleep Med Rev

Chest

Sleep Med

Sleep Med Rev

Heart Lung

Chest

Chest

J Psychosom Res

Patient Educ Couns

Sleep Med

Chest

Chest

Chest

Sleep Med

Chest

Sleep-related breathing disorders in adults: recommendation for syndrome definition and measurement techniques in clinical research

Sleep

Neuropsychological sequelae of obstructive sleep apnea syndrome: a critical review

J Int Neuropsychol Soc

Epidemiology of obstructive sleep apnea: a population health perspective

Am J Resp Crit Care Med

Obstructive sleep apnea implications for cardiac and vascular disease

J Am Med Assoc

Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults

Sleep

Patient Perception, Preference and Participation
Perceived informational needs, side-effects and their consequences on adherence—A comparison between CPAP treated patients with OSAS and healthcare personnel