CPAP titration completion: A correlational study
Acker, Katelijne Forrez
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Background: Sleep loss is a global public health burden with far-reaching social, economic, and health consequences. Obstructive sleep apnea (OSA) causes fragmented sleep and OSA prevalence in adults, 30-70 years of age, is 26%. About 30% of those drop the recommended CPAP treatment before initiation. In this study, the concept of CPAP adherence was expanded to include titration study completion as the first act of adherence. This study targeted a group that is rarely studied: the non-adherers. Participants: Consecutively sampled, CPAP-naïve, newly diagnosed OSA patients (N=155) completed a battery of questionnaires the evening of their diagnostic polysomnography, before receiving educational information. Methods: A predictive correlational study, using logistic regression, was conducted. Using valid and reliable surveys, cognitive concepts assessed were: (a) risk perception, (b) outcome expectancy, (c) self-efficacy, (d) locus of control, (e) health value, and (f) beliefs about OSA and CPAP. Physiological data were gathered from diagnostic sleep study results. Titration completion was assessed 90 days after diagnosis. Results: Lower OSA self-efficacy scores contributed significantly to titration non-completion prediction (OR= 0.95, p=.002). The final regression model explained about 31 % of the variance in titration non-completion and 83% of cases were correctly classified. Approximately 24 % of the participants did not complete a titration study. Respiratory disturbance index (RDI) was implicated in titration non-completion prediction. Conclusion: Participants’ beliefs about risks associated with OSA, their CPAP treatment expectations, and their perceived confidence in their ability to use CPAP influence titration non-completion, even measured before OSA diagnosis.