Cognitive and behavioral predictors of light therapy use

Objective: Although light therapy is effective in the treatment of seasonal affective disorder (SAD) and other mood disorders, only 53-79% of individuals with SAD meet remission criteria after light therapy. Perhaps more importantly, only 12-41% of individuals with SAD continue to use the treatment even after a previous winter of successful treatment. Method: Participants completed surveys regarding (1) social, cognitive, and behavioral variables used to evaluate treatment adherence for other health-related issues, expectations and credibility of light therapy, (2) a depression symptoms scale, and (3) self-reported light therapy use. Results: Individuals age 18 or older responded (n = 40), all reporting having been diagnosed with a mood disorder for which light therapy is indicated. Social support and self-efficacy scores were predictive of light therapy use (p's<.05). Conclusion: The findings suggest that testing social support and self-efficacy in a diagnosed patient population may identify factors related to the decision to use light therapy. Treatments that impact social support and self-efficacy may improve treatment response to light therapy in SAD. © 2012 Roecklein et al

Financial Incentive Increases CPAP Acceptance in Patients from Low Socioeconomic Background

OBJECTIVE: We explored whether financial incentives have a role in patients' decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing. DESIGN: Longitudinal interventional study. PATIENTS: The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330-660; the financial incentive group paid a subsidized price of$55. RESULTS: CPAP acceptance was 43% greater (p = 0.02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3.43, 1.09-10.85), age (1.1, 1.03-1.17), AHI (>30 vs. <30) (4.87, 1.56-15.2), and by family/friends who had positive experience with CPAP (4.29, 1.05-17.51). Among average/high-income patients (n = 145) CPAP acceptance was affected by AHI (>30 vs. <30) (3.16, 1.14-8.75), living with a partner (8.82, 1.03-75.8) but not by the financial incentive. At one-year follow-up CPAP adherence was similar in the financial incentive and control groups, 35% and 39%, respectively (p = 0.82). Adherence rate was sensitive to education (+yr) (1.28, 1.06-1.55) and AHI (>30 vs. <30) (5.25, 1.34-18.5). CONCLUSIONS: Minimizing cost sharing reduces a barrier for CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients

Heuristics for apnea episodes recognition

International Conference on Soft Computing Models in Industrial and Environmental Applications (10. 2015

0509 Patient and Provider Perspectives on Patient-Centered Outcomes in Sleep Apnea

Abstract Introduction Engaging patients and stakeholders in research is key to identifying patient-centered outcomes (PCOs). Our goal was to engage patients, providers, and other stakeholders across the entire spectrum of sleep medicine to identify PCOs related to obstructive sleep apnea (OSA). A secondary aim was to examine the patient-centeredness of research priorities in OSA by comparing patient’s ratings of priorities to those of providers. Methods Two conferences were held, which engaged eight stakeholder groups to ascertain important PCOs for OSA. Fifteen PCO domains were identified through semi-structured interviews of patients with OSA. An anonymous internet-based survey was administered to patients with OSA, providers, and other stakeholders through social media, to measure prioritization of outcomes on 100 mm visual analogue scales, ranging from 0 (unimportant) to100 (highly important) for each of the 15 PCO domains. Results The 1088 total respondents included 916 patients with OSA (29% male; age 56.7 ± 11.7 years) and 56 providers. The following six PCO domains had the highest patient ratings: Prevent long-term complications of sleep disorders (89 ± 19 [SD] on visual analogue scale); improve daytime functioning (88 ± 22); reduce mortality (89 ± 22); improve general health (81 ± 26); promote treatment adherence (80 ± 26); and improve sleep symptoms (86 ± 22; GLM; F=2.3; P=0.003). Other PCOs were improve sleep hygiene; reduce complications of co-existing medical conditions; prevent hospitalizations; improve access to healthcare; improve patient education; better manage treatment complications; treat coexistent mental health issues; better access to provider; and early detection of sleep disorder. After adjusting for covariates (age, sex, and race), there were no significant differences between patient and provider ratings of the 15 PCO domains (GLM; F=0.03; P=0.86). Age (F=13.8; P<0.0001) and sex (F=8.6; P=0.004) of the respondents played an important role in prioritizing PCOs. Conclusion These engagement efforts between patients and providers have yielded important insights about PCOs in sleep medicine. Good agreement was observed between patients and providers with regards to PCOs in OSA. The highly ranked PCO domains provide targets for future patient-centered clinical-trials. Support (If Any) PCORI-EAIN-3394-UOA

Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea

Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p &lt; 0.05). An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&amp;term=NCT02027558&amp;cntry=&amp;state=&amp;city=&amp;dist=Registration: NCT02027558