Using the Remote Monitoring Framework to Promote Adherence to Continuous Positive Airway Pressure
The ability to remotely monitor positive airway pressure therapy adherence and efficacy provides a unique opportunity for the field of sleep medicine to quickly and efficiently improve patient adherence. Smaller randomized studies and larger-scale retrospective evaluations show that telemedicine interventions leveraging these data can increase average usage and efficiency of care. However, more evidence on the impact of these programs on longer-term adherence and improving patient-reported outcomes is needed. Combining data from remote monitoring with clinical information in electronic health records may prove to be invalu...
Source: Sleep Medicine Clinics - December 23, 2020 Category: Sleep Medicine Authors: Brendan T. Keenan, Richard J. Schwab Source Type: research
Considering the Role of Adherence in New and Emerging Sleep Treatments
There are several novel and emerging treatments for obstructive sleep apnea (OSA), including new devices and pharmacotherapies. Long-term efficacy and adherence data for these interventions in the sleep context are lacking. Future studies exploring the long-term adherence and efficacy in novel and emerging treatments of OSA are required to fully understand the place of these treatments in treatment hierarchies. Such research also should aim to evaluate the use of these novel therapies in real-world clinical settings, because many of the studies performed to date have been done under closely monitored research populations a...
Source: Sleep Medicine Clinics - December 23, 2020 Category: Sleep Medicine Authors: Simon A. Joosten, Shane A. Landry, Ai-Ming Wong, Bradley A. Edwards Source Type: research
Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults
This article reviews studies published on behavioral interventions aimed at improving the uptake and ma intenance of PAP treatment (January 2016–February 2020). It discusses underlying factors in the poor uptake and discontinuation of treatment and the role of qualitative research to better understand the perspective of the patients. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 19, 2020 Category: Sleep Medicine Authors: Angela L. D ’Rozario, Yael Galgut, Megan Crawford, Delwyn J. Bartlett Source Type: research
Where to Next for Optimizing Adherence in Large-Scale Trials of Continuous Positive Airway Pressure?
Large-scale randomized trials of positive airway pressure (PAP) efficacy have been largely negative but PAP adherence was notably suboptimal across the trials. To address this limitation, evidence-based PAP adherence protocols embedded within the larger trial protocol are recommended. The complexity of such protocols depends on adequacy of resources, including funding and inclusion of behavioral scientist experts on the scientific team, and trial-specific considerations (eg, target population) and methods. Recommendations for optimizing PAP adherence in large-scale trials are set forth that address rigor and reproducibilit...
Source: Sleep Medicine Clinics - December 14, 2020 Category: Sleep Medicine Authors: Amy M. Sawyer, Douglas M. Wallace, Luis F. Buenaver, Alexa J. Watach, Amy Blase, Bruno Saconi, Sanjay R. Patel, Samuel T. Kuna, Naresh M. Punjabi Source Type: research
Adherence to Sleep Therapies in Children and Adolescents
Improved recognition of obstructive sleep apnea (OSA) in children has led many to identify effective strategies to treat pediatric OSA. Positive airway pressure (PAP) therapy in children, which has been shown to resolve OSA, is highly contingent on adequate adherence. In pediatrics, adherence is complex, related largely to the influence of age. Consequently, reported adherence rates in children are often lower than adults. Notwithstanding, studies have identified significant risk factors, some modifiable, and several intervention strategies that may improve pediatric adherence. Close follow-up, including use of cloud-based...
Source: Sleep Medicine Clinics - December 8, 2020 Category: Sleep Medicine Authors: Rakesh Bhattacharjee Source Type: research
Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome
This article discusses in detail the impact of PAP therapy on outcomes in patients with OHS, compares adherence between continuous PAP and noninvasive ventilation in OHS, and compares PAP adherence in patients with OHS to patients with moderate to severe OSA enrolled in clinical trials designed to improve CPAP adherence. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 8, 2020 Category: Sleep Medicine Authors: Jeremy Wearn, Bimaje Akpa, Babak Mokhlesi Source Type: research
Socioeconomic Disparities in Positive Airway Pressure Adherence
Nonadherence with positive airway pressure (PAP) therapy impedes the effectiveness of treatment and increases risk of mortality. Disparities in PAP adherence as a function of socioeconomic status (SES) are not well understood. A literature search identified 16 original publications meeting inclusion criteria that described effects of SES factors on objective PAP adherence; 69% of these articles found evidence of lower adherence as a function of SES. This integrative review provides a structured summary of the findings, highlights factors that may contribute to disparities among adult PAP users, and identifies future direct...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Earl Charles Crew, William K. Wohlgemuth, Amy M. Sawyer, Natasha J. Williams, Douglas M. Wallace Source Type: research
What Do We Know About Adherence to Oral Appliances?
Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1 year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effectivene...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Kate Sutherland, Oyku Dalci, Peter A. Cistulli Source Type: research
Alternative Care Pathways for Obstructive Sleep Apnea and the Impact on Positive Airway Pressure Adherence
The high burden of obstructive sleep apnea (OSA), combined with inadequate supply of sleep specialists and constraints on polysomnography resources, has prompted interest in alternative models of care to improve access and treatment effectiveness. In appropriately selected patients, ambulatory clinical pathways and use of nonphysicians or primary care providers to manage OSA can improve timely access and costs without compromising adherence or other clinical outcomes. Although initial studies show promising results, there are several potential barriers that must be considered before broad implementation, and further implem...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Martha E. Billings, Sachin R. Pendharkar Source Type: research
The Impact of Device Modifications and Pressure Delivery on Adherence
This article reviews the evidence to date examining whether adherence to positive airway pressure (PAP) therapy is affected by any device modifications to pressure delivery. To date there is no robust evidence from systematic reviews and meta-analyses indicating that any modification to standard fixed-pressure PAP makes a clinically significant difference to patient adherence to therapy. The main modifications are reviewed in this article and whether improving pressure could drive adherence, in turn improving patient outcomes, is discussed. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Roo Killick, Nathaniel S. Marshall Source Type: research
Can Smartphone Apps Assist People with Serious Mental Illness in Taking Medications as Prescribed?
This article presents adherence research as related to people with a diagnosis of a serious mental illness (SMI) and medication adherence through smartphone applications (apps). Individuals with SMI have high rates of not taking medication, increasing risks of relapse and hospitalization. Advances in technology may be advantageous in promoting taking medication. Smartphones apps have been designed for people with SMI. Further research is needed to evaluate their efficacy on improving rates of taking medication. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Cynthia L. Bianco, Amanda L. Myers, Stephen Smagula, Karen L. Fortuna Source Type: research
What is a Clinically Meaningful Target for Positive Airway Pressure Adherence?
Although good adherence to continuous positive airway pressure (PAP) traditionally is defined as greater than or equal to 4 hours/night, the origins and rationale for this remain unclear. Research studies report variation in optimal duration of PAP adherence, depending on outcome of interest. Evidence demonstrates benefit with PAP for daytime sleepiness, quality of life, neurocognitive outcomes, depression, and hyperte nsion, predominantly in symptomatic, moderate–severe obstructive sleep apnea. Recent randomized controlled trials, however, have failed to demonstrate a reduction in cardiovascular and mortality risks. T...
Source: Sleep Medicine Clinics - December 2, 2020 Category: Sleep Medicine Authors: Aaron Oh, Nicole Grivell, Ching Li Chai-Coetzer Source Type: research
Noninvasive Ventilation in Amyotrophic Lateral Sclerosis
This article discusses the indications, timing, initiation, and management of noninvasive ventilation in amyotrophic lateral sclerosis. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Authors: Jessica A. Cooksey, Amen Sergew Source Type: research
Management of Chronic Respiratory Failure in Chronic Obstructive Pulmonary Disease: High-Intensity and Low-Intensity Ventilation
This article reviews the physiologic basis for considering NIV in patients with COPD, summarizes existing evidence supporting the role of NIV in COPD, highlights the patient population and ventilatory approach most likely to offer benefit, and suggests a potential clinical pathway for managing patients. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Authors: Jeremy E. Orr, Ana Sanchez Azofra, Lauren A. Tobias Source Type: research
A Comprehensive View of Noninvasive Ventilation
Noninvasive ventilation (NIV), often referred to interchangeably as noninvasive positive pressure ventilation, is the focus of the current issue. One of the earliest uses of the modern day NIV machines dates to the 1940s when a group from Columbia University at Bellevue Hospital devised an “automatic respirator” to provide intermittent positive pressure ventilation using a facemask for patients with acute respiratory failure.1 NIV was used during the polio epidemic and was especially important for those with disabilities and chronic respiratory failure to be able to live independe ntly in community-based living centers...
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Authors: Lisa F. Wolfe, Amen Sergew Tags: Preface Source Type: research
