Sandeep P Khot1, Heather M Barnett2, Arielle P Davis3, Eeeseung Byun4, Barbara S McCann5, Charles H Bombardier2, Korren Rappisi2, W T Longstreth3, Martha E Billings6, Devin L Brown7, Michelle M Garrison8. 1. Department of Neurology, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA. Electronic address: skhot@uw.edu. 2. Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA. 3. Department of Neurology, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA. 4. Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA. 5. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA. 6. Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA. 7. Department of Neurology, University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA. 8. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA; Department of Health Services, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA.
Abstract
OBJECTIVE/ BACKGROUND: Continuous positive airway pressure (CPAP) for the treatment of sleep apnea may improve stroke recovery but is limited by poor adherence. We evaluated baseline features and psychosocial factors associated with CPAP adherence among stroke patients enrolled in a pilot study of an intensive CPAP adherence protocol initiated during inpatient rehabilitation. PATIENTS/ METHODS: In a retrospective analysis of a prospective cohort study, we compared participants adherent to CPAP (≥4 h for ≥70% of nights over 3 months) to non-adherent participants. Using mixed methods, we quantitatively compared baseline demographic and stroke-related factors associated with adherence and qualitatively compared facilitators and barriers to adherence. RESULTS: There were 32 adherent and 20 non-adherent participants. Quantitative analysis revealed more severe stroke, aphasia and white race were associated with adherence. Adherent compared to non-adherent participants also had fewer early CPAP complaints, especially claustrophobia. In a thematic qualitative analysis, facilitators of adherence included improvement in sleep and stroke symptoms, confidence in CPAP use, and positive treatment expectations. Conversely, barriers to adherence included both potentially modifiable factors (lack of confidence in CPAP use, discomfort with a new health technology, and common CPAP-related complaints), and less modifiable factors (social stressors, sleep disturbance, and lack of home social support). DISCUSSION: Adherence programs for CPAP use after stroke should address modifiable barriers, with early desensitization to improve CPAP-related complaints and claustrophobia, and training to address perceived self-efficacy with CPAP. Future studies should explore individual goals and barriers associated with CPAP use among stroke survivors to improve long-term CPAP adherence. CLINICAL TRIAL REGISTRATION NUMBER: NCT02809430.
OBJECTIVE/ BACKGROUND: Continuous positive airway pressure (CPAP) for the treatment of sleep apnea may improve stroke recovery but is limited by poor adherence. We evaluated baseline features and psychosocial factors associated with CPAP adherence among stroke patients enrolled in a pilot study of an intensive CPAP adherence protocol initiated during inpatient rehabilitation. PATIENTS/ METHODS: In a retrospective analysis of a prospective cohort study, we compared participants adherent to CPAP (≥4 h for ≥70% of nights over 3 months) to non-adherent participants. Using mixed methods, we quantitatively compared baseline demographic and stroke-related factors associated with adherence and qualitatively compared facilitators and barriers to adherence. RESULTS: There were 32 adherent and 20 non-adherent participants. Quantitative analysis revealed more severe stroke, aphasia and white race were associated with adherence. Adherent compared to non-adherent participants also had fewer early CPAP complaints, especially claustrophobia. In a thematic qualitative analysis, facilitators of adherence included improvement in sleep and stroke symptoms, confidence in CPAP use, and positive treatment expectations. Conversely, barriers to adherence included both potentially modifiable factors (lack of confidence in CPAP use, discomfort with a new health technology, and common CPAP-related complaints), and less modifiable factors (social stressors, sleep disturbance, and lack of home social support). DISCUSSION: Adherence programs for CPAP use after stroke should address modifiable barriers, with early desensitization to improve CPAP-related complaints and claustrophobia, and training to address perceived self-efficacy with CPAP. Future studies should explore individual goals and barriers associated with CPAP use among stroke survivors to improve long-term CPAP adherence. CLINICAL TRIAL REGISTRATION NUMBER: NCT02809430.
Authors: Stefan T Kotzian; Judith K Stanek; Michaela M Pinter; Wilfried Grossmann; Michael T Saletu Journal: Top Stroke Rehabil Date: 2012 Jan-Feb Impact factor: 2.119
Authors: Dawn M Bravata; John Concato; Terri Fried; Noshene Ranjbar; Tanesh Sadarangani; Vincent McClain; Frederick Struve; Lawrence Zygmunt; Herbert J Knight; Albert Lo; George B Richerson; Mark Gorman; Linda S Williams; Lawrence M Brass; Joseph Agostini; Vahid Mohsenin; Francoise Roux; H Klar Yaggi Journal: Stroke Date: 2010-05-27 Impact factor: 7.914
Authors: Dawn M Bravata; John Concato; Terri Fried; Noshene Ranjbar; Tanesh Sadarangani; Vincent McClain; Frederick Struve; Lawrence Zygmunt; Herbert J Knight; Albert Lo; George B Richerson; Mark Gorman; Linda S Williams; Lawrence M Brass; Joseph Agostini; Vahid Mohsenin; Francoise Roux; H Klar Yaggi Journal: Sleep Date: 2011-09-01 Impact factor: 5.849
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