Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 9, 2022
Date Accepted: Mar 15, 2023
Effectiveness of an intervention providing digitally generated personalized feedback and education on adherence to continuous positive airway pressure (CPAP): A randomized controlled trial
ABSTRACT
Background:
Many people worldwide suffer from Obstructive Sleep Apnea (OSA), which is associated with medical, psychological, and cognitive problems. Continuous positive airway pressure (CPAP) is an efficacious therapy for OSA, but its effect is limited by 30-60% non-adherence in treated patients. Studies show that providing personalized education and feedback are associated with increases in CPAP adherence. Moreover, tailoring the style of information to the psychological profile of a patient has been shown to enhance the impact.
Objective:
This study aims to assess the effect of a web-based intervention providing personalized education and feedback on CPAP adherence and to assess the additional effect on adherence of tailoring the style of the education and feedback to an individual’s psychological profile.
Methods:
This study was a 90-day multi-center, parallel, single-blinded, randomized controlled trial with three conditions: personalized content in a tailored style (PT) in addition to usual care; personalized content in a non-tailored style (PN) in addition to usual care; usual care (UC). To test the effect of tailored education and feedback, the PN+PT group was compared to UC. To test the additional effect of tailoring the style to the psychological profile, PN and PT groups were compared. 169 Participants were recruited from 6 United States sleep clinics. Primary outcome measures were adherence in terms of minutes of use per night and nights of use per week.
Results:
We found a significant positive effect of tailored education and feedback on both primary adherence outcome measures. The difference in average estimated adherence in minutes of use per night between the PT+PN and UC groups at day 90 was 81.3 minutes in favor of the PT+PN group (95% CI = [-134.00, -29.10]; p=.002). The difference in average adherence in nights of use per week between groups at week 12 was 0.9 nights per week in favor of the PT+PN group (difference in odds ratio 0.39; 95% CI = [0.21, 0.72]; p=.003). We did not find an additional effect on the primary adherence outcomes of tailoring the style of the intervention to the psychological profile. The difference in nightly use between PT and PN groups on day 90 (95% CI = [-28.20, 96.50]; p=.28) and the difference in nights of use per week between groups at week 12 (difference in odds ratio 0.85; 95% CI = [0.51, 1.43]; p = .054)) were both non-significant.
Conclusions:
The results show that personalized education and feedback can increase adherence to CPAP therapy substantially. We were not able to show that tailoring the style of the intervention to psychological profiles of patients can further increase adherence. Future research should investigate how the impact of interventions can be enhanced by catering for differences in psychological profiles of patients. Clinical Trial: ClinicalTrials.gov NCT02195531
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.