text: Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial
  Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial
  Sleep. 2007 May;30(5):635-40. doi: 10.1093/sleep/30.5.635.
  Authors
  Dianne Richards 1 , Delwyn J Bartlett, Keith Wong, John Malouff, Ronald R Grunstein
  Affiliation
  1 Royal North Shore Hospital, St Leonards, Sydney, Australia.
  PMID: 17552379
  DOI: 10.1093/sleep/30.5.635
  Abstract
  Study objective: To improve adherence to continuous positive airway pressure (CPAP) treatment in participants with obstructive sleep apnea (OSA) using a cognitive behavioral therapy (CBT) intervention.
  Design: A randomized controlled trial.
  Setting: A major teaching hospital in Sydney (2005).
  Participants: One hundred individuals (96 men), ranging in age from 32 to 81 years, diagnosed with OSA.
  Intervention: Two 1-hour CBT interventions (including a video of real CPAP users) plus treatment as usual (mask fitting and information) or treatment as usual only.
  Measurements and results: Hours of CPAP usage was assessed at 7 nights and 28 nights. Adherence was defined as usage at least 4 hours per night. Questionnaires measuring self-efficacy, social support, and expectancy (mediators of adherence) were given after intervention or after usual treatment. A higher adherence to CPAP therapy was found in the CBT group (2.9 hours difference) relative to treatment as usual (P < 0.001) at 28 days. Only 4 participants in the CBT group did not initiate treatments after their titration study, compared with 15 in the treatment as usual group (P < 0.02). The CBT group had significantly higher scores for self-efficacy (P < 0.001) and social support P < 0.008) but not for expectancy.
  Conclusions: The CBT intervention resulted in both increased adherence and "uptake" of CPAP and therefore would be expected to reduce the social, economic, and health-related consequences of untreated OSA.