Improving Adherence to PAP Therapy: an Update

Louis EK, Morgenthaler TI, Hoffmann CM, Hasanaj K, Hollingshead K, Yu TY, Buman MP. SleepWell24, a Smartphone Application to Promote Adherence to Positive Airway Pressure Therapy: Feasibility and Acceptability in a Randomized Controlled Trial

OBJECTIVE

To investigate the feasibility and acceptability of SleepWell24, a multicomponent, evidence-based smartphone application, to improve positive airway pressure therapy (PAP) adherence, among patients with obstructive sleep apnea (OSA) naive to PAP.

METHODS

In a single-blind randomized controlled trial, SleepWell24, with a companion activity monitor was compared to usual care plus the activity monitor and its associated app. SleepWell24 provides objective feedback on PAP usage and sleep/physical activity patterns, and chronic disease management. Patients were recruited from two sleep medicine centers and followed over the first 60 days of PAP. Feasibility and acceptability were measured by recruitment/retention rates, app usage, differences in post-trial Treatment Evaluation Questionnaire (TEQ) scores, and patient interviews. Exploratory, intent-to-treat logistic and linear mixed models estimated PAP adherence and clinical outcomes.

RESULTS

Of 103 eligible participants, 87 were enrolled (SleepWell24 n = 40, control n = 47; mean 57.6y [SD = 12.3], 44.8% female). Retention was ≥95% across arms. There were no significant differences in TEQ scores. SleepWell24 participants engaged with the app on 62.9% of trial days. PAP use was high across both arms (SleepWell24 vs. Control: mean hours 5.98 vs. 5.86). There were no differences in PAP adherence or clinical outcomes.

CONCLUSIONS

SleepWell24 was feasible and acceptable among PAP-naive patients with OSA.

CLINICAL TRIAL REGISTRATION

NCT03156283https://www.clinicaltrials.gov/study/NCT03156283.

Analysis of the characteristics of sleep in patients with patent foramen ovale complicated with obstructive sleep apnea

PURPOSE

Analyzing sleep quality and sleep structure in patients with patent foramen ovale (PFO) complicated with obstructive sleep apnea (OSA) and the interaction between OSA and PFO in sleep.

METHODS

We compared patients with PFO complicated with OSA, patients with simple PFO, and controls. Pittsburgh Sleep Quality Index was used to compare sleep quality and polysomnography was used to compare sleep structure of the three groups.

RESULTS

Compared with the control group (n = 62), PFO with OSA (n = 48) and simple PFO (n = 61) groups had more frequent occurrence of poor sleep quality (χ² = 89.901; p < 0.001). These two groups also showed decreased sleep efficiency (p < 0.010), lower percentages of REM sleep, and reduced N3 sleep (p < 0.050). The N2 sleep was prolonged (p < 0.010). The nocturnal lowest SpO₂ was lower and the oxygen desaturation index was higher (p < 0.50). Compared with the simple PFO group, the poor sleep quality was more frequent in the PFO with OSA group; sleep latency (p < 0.001) was prolonged; wake after sleep onset (p < 0.001) and arousal times (p = 0.031) were increased; and sleep micro-arousal index (p = 0.037), periodic leg movement index (p = 0.024), and apnea hypopnea index (p < 0.001) were higher in the PFO with OSA group.

CONCLUSION

Patients with PFO and OSA have poor sleep quality with changes in sleep stage and high occurrence rate of sleep disorders. OSA further deteriorates sleep quality and alters sleep structure in patients with PFO.

Predictors of Insomnia Severity Index Profiles in United States Veterans With Obstructive Sleep Apnea

STUDY OBJECTIVES

The Insomnia Severity Index (ISI) has been used to define insomnia symptoms in individuals with obstructive sleep apnea (OSA). However, whether distinct ISI profiles exist in individuals with OSA is unclear. The aims of this study were to determine (1) empirically-based ISI profiles in veterans with OSA and (2) predictors of these ISI profiles.

METHODS

Participants were 630 veterans with a new diagnosis of OSA over a 12-month period. Individuals completed the ISI and other questionnaires on the polysomnography (PSG) night. Latent profile analysis was performed to detect ISI subgroups based on individual ISI items. Age, Charlson Comorbidity Index, apnea-hypopnea index (AHI), mood disorder, posttraumatic stress disorder, and chronic pain diagnoses were used to predict between ISI profiles.

RESULTS

Latent profile analysis identified five ISI subgroups in veterans with OSA. The "asymptomatic" group (12% prevalence) had low scores across all ISI items. The "moderate insomnia" (30% prevalence) and "severe insomnia" (44% prevalence) groups had elevated scores for all ISI items but differing in severity. Last, the "moderate" (6% prevalence) and "severe daytime symptoms" groups (8% prevalence) were characterized by absence of nocturnal complaints but high scores on daytime impairment items. Age, AHI, mood disorder, posttraumatic stress disorder and chronic pain diagnoses discriminated between ISI profiles.

CONCLUSIONS

We describe data-driven ISI profiles in veterans with OSA. Older age was associated with lower insomnia and daytime symptom complaints whereas psychological comorbidities were related to more severe insomnia. Caution should be used in interpreting the ISI score in individuals with OSA because a subset had elevated total scores without insomnia.