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Gentina T, Gentina E, Douay B, Micoulaud-Franchi JA, Pépin JL, Bailly S. Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study. Front Neurol 2023; 14:1148700. [PMID: 37528857 PMCID: PMC10390224 DOI: 10.3389/fneur.2023.1148700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
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.
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Affiliation(s)
- Thibaut Gentina
- Ramsey General Healthcare La Louviere Hospital, Lille, France
| | - Elodie Gentina
- IESEG School of Management, CNRS, UMR 9221 – LEM – Lille Economie Management, Univ. Lille, Lille, France
| | - Bernard Douay
- Ramsey General Healthcare La Louviere Hospital, Lille, France
| | - Jean-Arthur Micoulaud-Franchi
- SANPSY, UMR 6033, University of Bordeaux, Bordeaux, France
- Sleep Medicine Service, University Hospital, Bordeaux, France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1300, Univ. Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1300, Univ. Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
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Gauld C, Rhanmi H, Philip P, Micoulaud-Franchi JA. Validation of the French Cues to CPAP Use Questionnaire in patients with OSAS: A step forward for evaluating cues to CPAP use in order to predict treatment adherence. J Psychosom Res 2022; 158:110943. [PMID: 35580454 DOI: 10.1016/j.jpsychores.2022.110943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The cues to starting CPAP are important in patients with Obstructive Sleep Apnea Syndrome (OSAS) to predict CPAP use and behavioral change. The Cues to CPAP Use Questionnaire (CCUQ) is a short practical self-reported scale to evaluate such cues to action. This study sought to examine the psychometric reliability and validity of the French version. METHODS A forward-backward translation of the CCUQ was performed. Principal research tools were CCUQ, SEMSA and ESS. Subjects with OSAS were invited to complete the CCUQ just before CPAP initiation and 10 days after CPAP initiation. The ESS was completed just before CPAP initiation and one month after CPAP initiation. The SEMSA was completed just before CPAP initiation. Statistical analyses methods aim to evaluate the psychometric properties of the French CCUQ version in terms of its construct validity, internal structural validity, test-retest and external validity. Mean CPAP use on the previous month was recorded at one, six and twelve months after CPAP initiation. RESULTS A total of 140 patients with OSAS were included with 61.4% of men and a mean age of 55.3 (±12.9), BMI of 29.8 (±4.9), initial ESS of 11.97 (±5.68), and initial AHI 37.2/h (±19.3). Factor analysis confirmed the three-factor structure of the CCUQ. Cronbach's alpha coefficient was 0.64. Test-retest reliability (at t-0 and at 10 days) of the CCUQ was satisfactory. External validity shown significant correlation of the CCUQ with SEMSA and of the dimension "Partner cues" of the CCUQ with mean CPAP use at one month. CONCLUSION The French CCUQ scale is a reliable and valid tool for measuring cues to action in adults with OSAS initiating CPAP treatment. Further studies are necessary to confirm the predictive value of cues to action and self-efficacy for CPAP use and adherence. Such investigations would underpin public health CPAP interventions in accordance with models of behavioral change.
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Affiliation(s)
- Christophe Gauld
- Service de Psychopathologie de l'Enfant et du Développement, Hospices Civils de Lyon, Lyon, France; UMR CNRS 8590 IHPST, Sorbonne University, Paris 1, France
| | - Hatim Rhanmi
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, 33 076 Bordeaux, France
| | - Pierre Philip
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, 33 076 Bordeaux, France; USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, 33 076 Bordeaux, France; USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, France.
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Joymangul JS, Sekhari A, Chatelet A, Moalla N, Grasset O. Obstructive Sleep Apnea compliance: verifications and validations of personalized interventions for PAP therapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2367-2373. [PMID: 34891758 DOI: 10.1109/embc46164.2021.9629905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Positive Airway Pressure (PAP) therapy is the most capable therapy against Obstruction Sleep Apnea (OSA). PAP therapy prevents the narrowing and collapsing of the soft tissues of the upper airway. A patient diagnosed with OSA is expected to use their CPAP machines every night for at least more than 4h for experiencing any clinical improvement. However, for the last two decades, trials were carried out to improve compliance and understand factors impacting compliance, but there were not enough conclusive results. With the advent of big data analytic and real-time monitoring, new opportunities open up to tackle this compliance issue. This paper's significant contribution is a novel framework that blends multiple external verification and validation carried out by different healthcare stakeholders. We provide a systematic verification and validation process to push towards explainable data analytic and automatic learning processes. We also present a complete mHealth solution that includes two mobile applications. The first application is for delivering tailored interventions directly to the patients. The second application is bound to different healthcare stakeholders for the verification and validation process.
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Merle R, Pison C, Logerot S, Deschaux C, Arnol N, Roustit M, Tamisier R, Pépin JL, Borel JC. Peer-driven intervention to help patients resume CPAP therapy following discontinuation: a multicentre, randomised clinical trial with patient involvement. BMJ Open 2021; 11:e053996. [PMID: 34649850 PMCID: PMC8522667 DOI: 10.1136/bmjopen-2021-053996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea syndrome (OSAS) is one of the most common chronic diseases. It may be associated with symptoms of excessive daytime sleepiness and neurocognitive and cardiovascular complications. First line therapy for OSAS involves home continuous positive airway pressure (CPAP), however, nearly half of patients do not adhere with this treatment over the long term. Cognitive-behavioural interventions that include health professionals and patient and public involvement are increasingly advocated in the fields of education and research. We hypothesise that a peer-driven intervention could help patients with OSAS to resume CPAP use after discontinuation. METHODS AND ANALYSIS We have designed a prospective, multicentre randomised, controlled trial that will be coconducted by health professionals, a home provider of CPAP and patients as experts or peers or participants. The primary aim is to evaluate the impact of a 6-month, peer-driven intervention to promote the resumption of CPAP after discontinuation. We anticipate that 20% of patients in the intervention group will reuse CPAP as compared with 6% in control group, thus, 104 patients must be included in each group. The secondary aims are (1) to evaluate the impact of the peer-driven intervention on adherence to CPAP compared with the control group (mean adherence and percentage of nights with at least 4 hours' use/night for 70% of nights); (2) to determine factors associated with resumption of CPAP; (3) to assess patient satisfaction with the peer-driven intervention at 6 months; (4) to evaluate the feasibility and the execution of the peer-driven intervention and peer satisfaction. Adult outpatients with an established diagnosis of severe OSA (Apnoea-Hypopnoea Index >30 events/hour) that have stopped using CPAP within 4-12 months after initiation will be recruited. The peers who will perform the intervention will be patients with OSAS treated with CPAP with good adherence (at least 4 hours/night, 70% of nights) and trained in motivational enhancement and cognitive-behavioural therapies. Trained peers will conduct three interviews within 6 months with participants. ETHICS AND DISSEMINATION Ethical approval has been obtained from the French Regional Ethics Committee CPP Ouest II-Angers, (IRB 21.02.25.68606 (2021/2025)). All participants will sign written informed consent. The results will be presented at conferences and published in peer-reviewed journals as well as public media. TRIAL REGISTRATION NUMBER NCT04538274.
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Affiliation(s)
- Raymond Merle
- Université Grenoble Alpes, Saint-Martin-d'Heres, France
| | - Christophe Pison
- Université Grenoble Alpes, Saint-Martin-d'Heres, France
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | | | | | | | - Matthieu Roustit
- Université Grenoble Alpes, Saint-Martin-d'Heres, France
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Alpes, France
| | - Renaud Tamisier
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- HP2; Inserm, U1042, Univ. Grenoble Alpes, Grenoble, France
| | - Jean Louis Pépin
- Université Grenoble Alpes, Saint-Martin-d'Heres, France
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Alpes, France
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Rudilla D, Galiana L, Landete P, Zamora E, Vergara I, Oliver A, Román A, Ancochea J. Development and Validation of the OSA-CPAP Perceived Competence Evaluation Interview. Arch Bronconeumol 2021; 57:399-405. [PMID: 34088391 DOI: 10.1016/j.arbr.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Continuous positive airway pressure (CPAP) is one of the most common therapies for Obstructive Sleep Apnea (OSA). We present a brief, patient-reported outcome measure used to assess patients' levels of adherence with CPAP treatment. METHODS A questionnaire was developed based on academic literature. We qualitatively tested a pool of 18 items. It was tested in a sample of 174 patients from the Hospital La Princesa. Next, 1021 patients from Catalonia were evaluated. RESULTS 5 items were removed. Nominal groups referred to three areas: general knowledge about OSA and its risks; CPAP treatment information and expectations; CPAP use, monitoring, and confidence with its use. The 13 retained items maintained the same meaning as the original questionnaire (r=.986; p<.001) and the three proposed dimensions detected a significant increase in general knowledge of OSA (t[173]=8.097, p<.001); CPAP treatment information (t[173]=15.170, p<.001); and CPAP use (t[173]=14.642, p<.001). The final 12-item version was reliable (CRI=.793) and its internal structure was adequate (χ2[51]=72.073; p=.027, CFI=.967, RMSEA=.020 [.000, .030]). Women had a better general knowledge of OSA (t[1,018]=2.190, p=.029), CPAP treatment information (t[1,018]=2.920, p=.004), and higher overall OSA-CPAP scores (t[1,018]=3.093, p=.002). Scores were positively related to quality of life and motivation, adherence was positively related to CPAP use and monitoring, and the total score was negatively related to daytime sleepiness. CONCLUSIONS The interview could help clinicians prevent some dropouts by targeting patients with lower adherence. It's a tool for assessing patient adherence to CPAP and to promote strategies through education and external motivational stimuli.
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Affiliation(s)
- David Rudilla
- Air Liquide Healthcare, Spain; Pneumology, Hospital Universitario de La Princesa, Spain.
| | - Laura Galiana
- Faculty of Psychology, Departamento de Metodología de las Ciencias del Comportamiento, Universidad de Valencia, Spain
| | - Pedro Landete
- Pneumology, Hospital Universitario de La Princesa, Spain
| | - Enrique Zamora
- Pneumology, Hospital Universitario de La Princesa, Spain
| | | | - Amparo Oliver
- Faculty of Psychology, Departamento de Metodología de las Ciencias del Comportamiento, Universidad de Valencia, Spain
| | | | - Julio Ancochea
- Pneumology, Hospital Universitario de La Princesa, Spain
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Rudilla D, Galiana L, Landete P, Zamora E, Vergara I, Oliver A, Román A, Ancochea J. Development and Validation of the OSA-CPAP Perceived Competence Evaluation Interview. Arch Bronconeumol 2020. [PMID: 32948366 DOI: 10.1016/j.arbres.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Continuous positive airway pressure (CPAP) is one of the most common therapies for Obstructive Sleep Apnea (OSA). We present a brief, patient-reported outcome measure used to assess patients' levels of adherence with CPAP treatment. METHODS A questionnaire was developed based on academic literature. We qualitatively tested a pool of 18 items. It was tested in a sample of 174 patients from the Hospital La Princesa. Next, 1021 patients from Catalonia were evaluated. RESULTS 5 items were removed. Nominal groups referred to three areas: general knowledge about OSA and its risks; CPAP treatment information and expectations; CPAP use, monitoring, and confidence with its use. The 13 retained items maintained the same meaning as the original questionnaire (r=.986; p<.001) and the three proposed dimensions detected a significant increase in general knowledge of OSA (t[173]=8.097, p<.001); CPAP treatment information (t[173]=15.170, p<.001); and CPAP use (t[173]=14.642, p<.001). The final 12-item version was reliable (CRI=.793) and its internal structure was adequate (χ2[51]=72.073; p=.027, CFI=.967, RMSEA=.020 [.000, .030]). Women had a better general knowledge of OSA (t[1,018]=2.190, p=.029), CPAP treatment information (t[1,018]=2.920, p=.004), and higher overall OSA-CPAP scores (t[1,018]=3.093, p=.002). Scores were positively related to quality of life and motivation, adherence was positively related to CPAP use and monitoring, and the total score was negatively related to daytime sleepiness. CONCLUSIONS The interview could help clinicians prevent some dropouts by targeting patients with lower adherence. It's a tool for assessing patient adherence to CPAP and to promote strategies through education and external motivational stimuli.
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Affiliation(s)
- David Rudilla
- Air Liquide Healthcare, Spain; Pneumology, Hospital Universitario de La Princesa, Spain.
| | - Laura Galiana
- Faculty of Psychology, Departamento de Metodología de las Ciencias del Comportamiento, Universidad de Valencia, Spain
| | - Pedro Landete
- Pneumology, Hospital Universitario de La Princesa, Spain
| | - Enrique Zamora
- Pneumology, Hospital Universitario de La Princesa, Spain
| | | | - Amparo Oliver
- Faculty of Psychology, Departamento de Metodología de las Ciencias del Comportamiento, Universidad de Valencia, Spain
| | | | - Julio Ancochea
- Pneumology, Hospital Universitario de La Princesa, Spain
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