I have a mild case of sleep apnea (6.5 times an hour), use of a CPAP makes it impossible for me to sleep. My doctor never considered my exhaustion could be sleep apnea rather than the stroke, but then he never knew anything about stroke either. I quit using it so I could actually sleep, no clue if it still exists, no partner to tell me otherwise.
Factors influencing adherence to positive airway pressure therapy in stroke patients with obstructive sleep apnea: a cross-sectional study
Wen-Yi Yu
Li-Wen Xu
Shu-Tong Sun
Yi-Xi Zheng1- 1Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- 2School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
Background: Positive Airway Pressure (PAP) treatment is the recommended initial approach for moderately severe obstructive sleep apnea patients. Its efficacy is contingent upon patient compliance, yet compliance studies in combined stroke and obstructive sleep apnea (OSA) patients have demonstrated lower rates of compliance, and most of the influencing factors are unregulated. This study aimed to explore short-term respiratory therapy compliance status among stroke patients with obstructive sleep apnea and identify modifiable influencing factors to improve compliance and create personalized plans.
Methods: This study was conducted among 254 stroke patients with OSA. Data were collected using standardized questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Self-Efficacy Measure for Sleep Apnea (SEMSA). Polysomnography (PSG) was used to assess objective sleep parameters. Logistic regression analysis was performed to identify predictors of PAP adherence.
Results: The overall compliance rate of stroke patients with OSA was 27.2%, and self-efficacy in patients with stroke combined with OSA (perceived risk (OR = 2.23, 95% CI = 1.74 ~ 2.83), expected effect of treatment (OR = 1.23, 95% CI = 1.23 ~ 1.4), self-assessment (OR = 1.17, 95% CI = 1.06 ~ 1.30), total score on the Health Beliefs Scale (OR = 1.20, 95% CI = 1.13 ~ 1.26)), objective sleep condition (total sleep duration (OR = 1.00, 95% CI = 1.00 ~ 1.01), sleep efficiency (OR = 1.00, 95% CI = 1.00 ~ 1.04)) (OR = 1.01, 95% CI = 1.00 ~ 1.02), N1 phase duration (OR = 1.01, 95% CI = 1.00 ~ 1.01)), OSA severity (AHI (OR = 1.04, 95% CI = 1.02 ~ 1.06), and longest hypoventilation time (s) (OR = 1.02, 95% CI = 1.00 ~ 1.03), and oxygen desaturation ≥3 index (ODI) (OR = 1.03, 95% CI = 1.01 ~ 1.05) were the risk factors affecting their PAP treatment.
Conclusion: Patients with stroke combined with OSA have poorer compliance to PAP treatment (27.2%) compared with the general population, and this compliance is closely related to self-efficacy, objective sleep, and the severity of OSA. In the future, we can combine with the Health Belief Models to formulate an individualized intervention plan based on patients’ self-efficacy.
1 Introduction
Obstructive sleep apnea (OSA) is a common chronic condition marked by the partial or complete collapse of the upper airway during sleep. This disorder leads to various pathophysiological effects (1), such as fragmented sleep, intermittent low oxygen levels, excessive daytime sleepiness, and altered sleep patterns. Strong epidemiological studies have established OSA as an independent risk factor for both the occurrence and recurrence of strokes (2–4). Additionally, individuals with OSA often experience poorer functional recovery, longer hospital stays, and a higher risk of mortality (5). The interaction of undiagnosed and untreated obstructive sleep apnea (OSA) presents a significant public health challenge, as it places an undue burden on healthcare systems and socioeconomic structures. Positive airway pressure (PAP) therapy is the primary treatment for OSA, working by stabilizing the upper airway through the delivery of pressure via a mask during sleep. Research from randomized controlled trials has shown that consistent use of PAP therapy for at least 4 h each night can improve cognitive performance, enhance sleep quality, reduce excessive daytime sleepiness, and support neurological recovery (6–9), However, the effectiveness of this treatment heavily relies on patient adherence, which is notably lower among stroke survivors compared to those with OSA who have not experienced a stroke (10).
The Health Belief Model (HBM), a value-expectancy theory grounded in social cognitive principles (11), elucidates health behavior determinants through dual appraisal processes: threat perception involving disease susceptibility and severity evaluations, and behavioral assessment weighing intervention benefits against implementation barriers (12). With the advancement of HBM, this study provides a compelling illustration of the significant role that health education plays in enhancing the effectiveness and benefits of patients’ perceived health behaviors. For researchers, it offers a valuable theoretical framework. Moreover, it serves as a foundation for evaluating the factors influencing patients’ non-adherence behavior and devising personalized intervention plans (13). While existing research has established a dose-dependent relationship between Health Belief Model (HBM) constructs and Positive Airway Pressure (PAP) adherence in general populations with Obstructive Sleep Apnea (OSA), this conceptual framework has been notably underexplored in populations with post-stroke OSA.
To address the significant gap in evidence, this study utilizes the Health Belief Model (HBM) to thoroughly assess patient perceptions across five important areas: perceived susceptibility, perceived severity, beliefs about treatment effectiveness, thresholds for perceived benefits, and hierarchies of perceived barriers. These findings aim to create a solid empirical framework that can guide the development of tailored behavioral interventions, specifically designed to improve adherence to respiratory therapy among patients at high risk.
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