Behavioral KSA Intervention Class to Boost Positive Airway Pressure Adherence Among Active Duty Military Personnel With Obstructive Sleep Apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is a treatable cause of daytime sleepiness and associated medical problems that can negatively impact soldier readiness and performance. This study examined adherence to positive airway pressure (PAP) by soldiers who were newly diagnosed with OSA and prescribed PAP therapy and participated in a Knowledge, Skills, and Attitudes (KSA) behavioral intervention class. MATERIALS AND METHODS: The KSA was a one-time, interactive 90-minute class attended by up to 10 patients per class. PAP adherence was examined using Medicare standard at 30-, 60-, 90-, and 180 days post class. The analytic sample comprised 379 active duty patients (93% men; mean age 40.21 ± 8.06) categorized into 3 groups: KSA (n = 235), did not show (DNS; n = 61), and mandatory education class (MEC; n = 83). The MEC group comprised patients from an education class in a previous year. RESULTS: Baseline scores on the apnea hypopnea index, body mass index, sleepiness, insomnia severity, and age were non-significant among the 3 groups. At 30 days, significantly more patients in KSA (48%) and MEC (51%) were adherent than the DNS group (16%). At 60 days, the adherence rates for the KSA, DNS, and MEC were significantly different at 39%, 22%, and 27%, respectively. At 90- and 180 days, the adherence rates among the KSA, DNS, and MEC groups did not differ significantly at 34%, 17%, and 26% (90 days) and 34%, 27%, and 25% (180 days), respectively. Consistently, more patients in KSA were adherent than those in DNS and MEC, except at 30 days. Additionally, adherence rates for KSA intervention declined more gradually over the 6 month period. The mean PAP usage on nights used was 4.6 hours that computed to a 34% non-use rate based on an optimal 7-hour/night sleep time. CONCLUSION: KSA could be a behavioral intervention that enhances PAP adherence with a booster session implemented at the 90 days mark.

Predictors of Positive Airway Pressure Therapy Adherence Among U.S. Active Duty Military Personnel With Obstructive Sleep Apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is prevalent among U.S. military personnel, but adherence to positive airway pressure (PAP) treatment is suboptimal. This study sought to identify factors that predict the adherence to PAP therapy of active duty military patients newly diagnosed with OSA. MATERIALS AND METHODS: The study was a retrospective cross-sectional analysis of 239 active duty military patients (94% men, mean age 40.0 ± 7.8 years), who were admitted into PAP therapy and participated in a single 90-minute behavioral intervention session. The session included a self-assessment of sleep trouble, sleep distress, impact of sleep on functioning, emotional difficulty from sleep, stress appraisal, and beliefs about OSA and PAP. PAP usage data of the patients were analyzed at 30-, 60-, and 180 days post-intervention using descriptive statistics and multivariable linear regression analysis. RESULTS: Positive airway pressure adherence of at least 4 hours nightly usage decreased slightly over the course of the study; mean number of days used over a 30-day timeframe at the 30-, 60-, and 180-day mark were 15.6, 14.9, and 14.1 days, respectively. On nights used, PAP usage remained consistent at 4.8 to 5.0 hours over the 30-, 60-, and 180-day mark. Age, apnea-hypopnea index, readiness, self-efficacy or confidence in treatment implementation, and worries about sleep were statistically significant predictors of adherence. Furthermore, worries about sleep negatively affected PAP usage hours on nights used, regardless of meeting adherence criterion, in the early phase of treatment and in the long run at the 180-day mark. CONCLUSIONS: Readiness for therapy, self-efficacy, confidence in putting into action the treatment plan, and worries about sleep are modifiable variables that may be targeted in programs to boost PAP adherence and usage among the military population. Future studies should explore the predictive aspects of each of these variables and identify interventions to improve them.