Enhancing patients' self-regulation of obstructive sleep apnea: The effect of self-monitoring and objective monitoring.

摘要

Self-monitoring has been shown to increase adherence to chronic treatment regimens and is one aspect of behavioral self-regulation. A four-phase cognitive-behavioral model of self-regulation (disease symptom avoidance, disease acceptance, disease compliance, and disease self-regulation in sequentially improving order) has predicted treatment adherence in children with chronic asthma (Zimmerman, Bonner, Evans, & Mellins, 1999). The purpose of this study was to test the hypothesis that self-monitoring of continuous positive airway pressure (CPAP) use and/or greater self-regulation would improve CPAP adherence in patients with obstructive sleep apnea (OSA).; Patients newly diagnosed with OSA were prescribed their successfully titrated levels of CPAP using a machine that monitored hours of nightly use at the prescribed pressure (ResMed, Elite), then randomly assigned to either a self-monitoring (S) or non-self-monitoring (NS) condition. For the first 30 days, the S group was asked to record nightly CPAP use. The NS group received identical clinical instruction and counseling, but was not asked to self-monitor. For the second 30 days, the experimental conditions were reversed. Phase of OSA self-regulation at follow-up was assessed by analysis of responses to a qualitative research instrument, the OSA Self-Regulatory Development Interview (OSASRDI).; At 30-day follow-up the S group used CPAP for more hours per night than the NS group. In addition, OSA self-regulatory patients used CPAP for more hours per night than both OSA compliant, and OSA acceptant patients. In general, those patients who self-recorded and were OSA self-regulatory used CPAP more than all other sub-groups.; At 60-day follow-up, the effects of self-recording had dissipated. OSA self-regulation phase at 60-days was a significant predictor of CPAP use at 60-days. Of those variables measured at 30-day follow-up, OSA self regulatory phase at 30-days was the sole significant predictor of hours of nightly CPAP use at 60-days.; OSA self-regulatory behavior, coupled with self-recording, was particularly effective in establishing early adherence to CPAP. Therefore, self-recording should be introduced and monitored with, or very soon after, the provision of CPAP. Similarly, self-regulation training should be provided at about the same time, and in a manner appropriate to the OSA self-regulation phase of each patient.