title: Patient education combined in a music and habit-forming intervention for adherence to continuous positive airway (CPAP) prescribed for sleep apnea.
abstract: OBJECTIVE
  As many as 50% of patients diagnosed with obstructive sleep apnea stop adhering to the prescribed medical treatment of continuous positive airway pressure (CPAP) within 1-3 weeks of onset. Thus, a theory-based intervention using music to support habit formation was designed to improve CPAP adherence at onset. The intervention materials included directions for CPAP nightly use, a diary for recording nightly use and writing about CPAP benefits or problems. In addition, an audiotape with softly spoken instructions for placing the CPAP mask comfortably, using deep breathing and muscle relaxation along with the slowly decreasing music tempo was provided to listen to at bedtime each night.
  
  
  METHODS
  Effects of this music intervention were tested in a randomized, placebo-controlled trial of 97 patients with 53 males (55%) and 44 females (45%). Moderate to severe apnea/hyponea scores (per sleep laboratory data) and medical diagnosis of OSA were required for study inclusion.
  
  
  RESULTS
  Compared to placebo controls, a greater proportion of experimental patients were adhering (chi(2)=14.67, p<0.01; a large difference, Phi=0.39) at the end of the first month of CPAP onset. There were no differences in CPAP adherence at 3 (X(2)=0.065, p=0.79) and 6 (X(2)=.118, p=0.73) months. Patients' diary data and satisfaction survey results indicated the intervention was rated as helpful and guided formation of a relaxing, habitual routine of CPAP nightly use.
  
  
  CONCLUSIONS
  The intervention had a strong effect for improving adherence to CPAP at 1 month.
  
  
  CONCLUSIONS
  Adherence at the onset of treatment is critical and the audio music intervention was easily administered. Other interventions that target problems interfering with longer-term CPAP adherence are needed.
authors.affiliation: University of Kansas, School of Nursing and Preventive Medicine, 3062 School of Nursing Building, 3901 Rainbow Boulevard, Mailstop 4043, Kansas City, KS 66160-7502, United States. csmith@kumc.edu
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
authors.forename: Emily
authors.initials: E
authors.lastname: Dauz
authors.forename: Faye
authors.initials: F
authors.lastname: Clements
authors.forename: Marilyn
authors.initials: M
authors.lastname: Werkowitch
authors.forename: Robert
authors.initials: R
authors.lastname: Whitman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D003863:Depression / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006184:Habits; D006801:Humans; D008297:Male; D008875:Middle Aged; D009147:Music Therapy / Q000379:methods*; D009765:Obesity / Q000150:complications; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D011582:Psychological Theory; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires; D013637:Tape Recording