AT SLEEP 2017
BOSTON (FRONTLINE MEDICAL NEWS) – Showing patients videos of themselves having apneic episodes may convince them to use continuous positive airway pressure (CPAP), suggests the first results of an ongoing randomized clinical trial.
The investigators based their research project design on a previous pilot study that showed improved adherence to CPAP in patients who were shown videos of themselves sleeping while participating in a sleep study, Mark S. Aloia, PhD, said in a presentation at the annual meeting of the Associated Professional Sleep Societies.
In the new study, patients who had been recently diagnosed with sleep apnea were randomly assigned to participate in one of the three treatment groups. All three groups received sleep apnea and CPAP education prior to the use of CPAP. One group also watched videos of themselves sleeping, snoring, and gasping for air, and another group watched videos of a stranger sleeping and having apneic events.
In this study’s preliminary findings for 24 patients, those who were shown brief videos of themselves sleeping used their prescribed CPAP treatment for a mean of 6.5 hours per night across a 99-day time period. In contrast, those who watched a video of a stranger sleeping had a mean CPAP use of 4.1 hours, and those who received standard CPAP education used their devices a mean of 3.5 hours per night.
After adjustment for age, educational level, and baseline sleep apnea severity, those who watched videos of themselves still used their CPAP devices more than 2 hours per night longer than did patients in each of the groups receiving the other two interventions (P = .02).
Both video interventions involved watching 30 minutes of sleep footage shown to each patient once before starting CPAP therapy. CPAP adherence was measured by downloaded data from PAP devices over the first 90 days of use.
The average age of the patients was 50 years, and they had moderate or severe sleep apnea, with mean apnea hypopnea indices ranging from 26.5 to 33.3 in the three study arms. The majority of patients had body mass indexes over 30.
Adherence to CPAP treatment is often poor, with many patients failing to use the device for even 4 hours per night, said Dr. Aloia, a psychologist at National Jewish Health in Denver. Many patients prescribed CPAP for OSA will undergo an educational component that may include watching a video of someone with OSA sleeping and having apneic events, he added. They often have “dramatic responses” to these videos, but then fail to positively change their own behavior.
“Many times we think that if our patient just knew what we know, he or she would use CPAP more, but there is evidence that doctors don’t take their medications any more than patients do, so it is not just a matter of education, it is a little bit deeper than that and it has to be personalized,” he said.
“The use of a personalized video is promising … we hope to present more data next year,” said Dr. Aloia, who has board certification in behavioral sleep medicine,
He noted that the video technique used may be jeopardized as more and more patients partake in home-based rather than lab-based sleep studies. That said, he also reported that the research team had to exclude several patients from the study because they had already viewed videos of themselves sleeping and snoring that had been recorded by their partners.
If the intervention proves effective, Dr. Aloia said he thinks it can be modified for use in home testing.
The study is supported by a grant from the National Heart, Lung, and Blood Institute. Dr. Aloia disclosed that he is a paid employee of Phillips, but that the study used both Phillips and ResMed CPAP devices.