Risk Perception, Treatment Self-Efficacy of CPAP in OSA Similar Regardless of Sex
Although the sample size was relatively small, the findings provide insight into predictors of adherence to CPAP, which has been known to limit the effectiveness of the therapy.
Andrey Zinchuk, MD, MHS
Data from the prospective, observational, NICEPAP study (NCT05067088), indicated no statistically significant differences in risk perception, outcome expectancy, or treatment self-efficacy between men and women with obstructive sleep apnea (OSA).1
Presented at the 2022 SLEEP Annual Meeting, June 4-8, in Charlotte, North Carolina, the study included 33 adult women and 19 adult men of the 267 individuals enrolled to date with newly diagnosed OSA who were prescribed CPAP therapy. Senior author Andrey Zinchuk, MD, MHS, associate professor and director, Advanced Apnea Management Program, Yale School of Medicine, and colleagues aimed to better understand differences in risk perception, outcome expectancy, and treatment self-efficacy, all of which play a role in adherence to CPAP. Previous studies have shown that the effectiveness of CPAP can be limited due to adherence.
The women and men were a median of 52 years old (range, 41.0-60.5) and 52 years old (range, 35.0-58.0), respectively, at the time of the study. Those with a need for a non-CPAP therapy or unstable medical conditions, such as cancer receiving chemotherapy, severe lung, heart, or mental health disorders, were excluded from the analysis. The coprimary outcomes were subscale scores from the Self-Efficacy Measure for Sleep Apnea (SEMSA) tool: Perceived Risk, Outcome Expectancies, and Treatment Self-Efficacy. Additionally, patients were assessed on several other psycho-social and behavioral CPAP adherence predictors using validated measures.
Using Kruskal-Wallis statistics, there were no differences found in scores of Perceived Risk (women: 2.4 [95% CI, 1.6-2.9]; males: 2.1 [95% CI, 1.8-2.5]; P = 0.717), Outcome Expectancies (women: 2.8 [95% CI, 2.3-3.4]; men: 3.3 [95% CI, 2.4-3.5]; P = 0.371), or Treatment Self-Efficacy (women: 3.1 [95% CI, 2.3-3.7]; men: 3.1 [95% CI, 2.0-3.5]; P = 0.977). For women, the Epworth Sleepiness Scale and insomnia severity index scores were 9.0 (95% CI, 5.0-12.0) and 15.0 (95% CI, 11.0-18.0) vs 6.0 (95% CI, 4.0-9.0) and 17.0 (95% CI, 8.0-19.5) for men.
READ MORE: CPAP Withdrawal in Obstructive Sleep Apnea Results in Changes to Neurodegenerative Plasma Biomarkers
"Our findings may reflect a small sample size recruited to date or that self-efficacy of CPAP therapy is independent of sex,” Sharma et al wrote.
Although limited, there has been research aimed at understanding treatment perceptions of CPAP use. One notable 2011 prospective, longitudinal study included 66, middle-aged individuals with severe OSA who had home CPAP use objectively measured at 1 week and 1 month after full-night diagnostic/CPAP polysomnograms. At the conclusion of the study, CPAP use at 1 week was 3.99 (±2.48) hours per night and 3.06 (±2.43) hours per night at 1 month.2
The SEMSA questionnaire measuring risk perception, outcome expectancies, and self-efficacy, was collected at baseline, post-CPAP education, and after 1 week of CPAP treatment. No baseline SEMSA domains influenced CPAP use; however, post-education self-efficacy influenced one week CPAP use (1.52 hour/night; ±0.53; P = .007). Additionally, self-efficacy measured post-education (1.40 hour/night; ±0.52; P = .009) and after 1 week of CPAP (1.20 hour/night; ±0.50; P = .002) also influenced CPAP use at 1 month.
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