Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study.

Study objectives: The prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study. Methods: Eligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up. Results: Enrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy. Conclusion: SEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway.

Mindfulness buffers the deleterious effects of workaholism for work-family conflict.

RATIONALE: Workaholism logically corresponds to the experience of work-family conflict (WFC) which is associated with a wide variety of negative employee outcomes. Finding ways to mitigate the occurrence of workaholism and/or lessen its deleterious effects on the work-family interface is practically important. Mindfulness research may hold some promise in this regard. OBJECTIVE: We explore the potential that mindfulness - through its association with accuracy and salience of present moment experience and disengagement from automatic thoughts and debilitating behavior - may buffer the effects of workaholic tendencies on the experience of WFC. METHODS: We use a two-study design (total n = 1022) to examine the role of dispositional mindfulness and mindfulness practice on the workaholism-WFC relationship. RESULTS: Results suggest that (1) trait mindfulness buffers the workaholism-WFC relationship (Study 1; n = 307), and that (2) mindfulness practice and mindfulness training similarly buffer this relationship (Study 2; n = 715). CONCLUSION: Mindfulness effectively serves as a buffer in the relationship between workaholism and WFC.

Multidimensional Evaluation of Continuous Positive Airway Pressure (CPAP) Treatment for Sleep Apnea in Different Clusters of Couples.

Continuous positive airway pressure (CPAP) is the most efficient treatment of obstructive sleep apnea (OSA). Little is known about the impact of spousal relationship profiles on CPAP adherence. We aimed to identify clusters of couples of OSA patients, and their association with CPAP adherence 120 days after CPAP initiation. In a multicenter prospective study, OSA patients recently prescribed CPAP were enrolled with their spouses. Data about spousal relationships were collected at inclusion and at day 120. Latent class analysis was performed to determine homogeneous groups of spousal relationships. The 290 participants were predominantly males (77%), median age was 53 years and interquartile range (IQR) 46-62, median body mass index (BMI) was 32 kg/m² (IQR: 28.6-35.9) and median apnea-hypopnea index: 43 events per hour (IQR: 33-58). Three couple clusters were identified: 1) older retired couples, 2) young working couples, and 3) mature active couples. Patients in the older retired couples cluster presented the highest CPAP adherence (p < 0.01) independently of initial complaints, OSA severity, and degree of improvement under CPAP. In a large cohort of OSA patients in whom clusters of couples were determined, there was a significant difference in CPAP adherence at day-120 after CPAP initiation.

Marital quality, partner's engagement and continuous positive airway pressure adherence in obstructive sleep apnea.

BACKGROUND: Continuous positive airway pressure (CPAP) is the first line therapy for obstructive sleep apnea (OSA) but its effectiveness requires high adherence. We aimed to assess the impacts of the spouse's/partner's involvement and the quality of the couple's relationship on CPAP adherence. METHODS: In a multicenter prospective study conducted in France, patients reported their subjective views regarding their partner's engagement in their CPAP treatment and the quality of their marital relationship using the Quality of Marriage Index. A hierarchical linear model was built to assess the predictors of CPAP adherence at day 120. Structural equation modeling was performed to evaluate the direct and indirect effects of the spouse's/partner's engagement and the quality of the couple's relationship on CPAP adherence. RESULTS: The 290 OSA patients were predominantly male (77%), with a median age of 53 years IQR: [46; 62], median BMI: 32 kg/m2 [28.6; 35.9] and median apnea + hypopnea index: 43/per hour [33; 58]. Independent factors for CPAP adherence at day 120 were the partner's encouragement of CPAP usage and a stable relationship exceeding 30 years, although emotional support or collaboration were not associated with CPAP adherence. Structural equation modeling demonstrated that spouse's/partner's engagement is directly related to CPAP adherence and improvement of symptoms, and that CPAP adherence is a mediator of disease-specific health-related quality of life. Marital quality was a significant moderator of these interactions meaning that a spouse's/partner's engagement improved adherence only when the quality of marriage index was high. CONCLUSION: Future research and integrated OSA management should systematically include and document the role of the spouse/partner in CPAP adherence.

Different Effects of Social Support on Adolescent Smoking and the Mediation by Smartphone Dependence.

BACKGROUND AND AIMS: This study examines the relationship between social support (from parents and peers) and cigarette use, through the mediating effect of smartphone dependence, among adolescents. STUDY DESIGN: Prospective cohort study. METHODS: A survey, conducted among 472 adolescents (average age = 16.2 years) attending classes in 3 schools in Lille, France, provides the data. The theoretical model features social support (parental and peer) and cigarette use, with smartphone dependence as a mediator, such that the authors simultaneously examine direct (support → cigarette use) and indirect (eg, peer support → smartphone dependence → cigarette use) paths. RESULTS: The results illustrate that both parental support and peer support discourage cigarette use, but the indirect effect through smartphone dependence is positive. That is, smartphone dependence mediates the relationship between peer support and cigarette use. Parental support and peer support shape adolescents' cigarette use and smartphone dependence differently, depending on the adolescents' gender. CONCLUSIONS: Policy makers should acknowledge the positive effects of social support, the negative effect of smartphone dependence, and the importance of gender when developing anti-smoking policies and campaigns.