title: Spousal involvement in CPAP adherence among patients with obstructive sleep apnea.
abstract: OBJECTIVE
  To determine the effects of spousal involvement on continuous positive airway pressure (CPAP) adherence and response to CPAP problems in male patients with obstructive sleep apnea (OSA).
  
  
  METHODS
  Wives' involvement (pressure, support, and collaboration), CPAP adherence and CPAP problems (e.g., mask leaks) were assessed for 10 days in 31 male OSA patients. Disease severity and pre-treatment ratings of relationship quality were tested as moderators of daily associations in multilevel models. Effects of wives' involvement were tested as predictors of day-to-day adherence and average nightly adherence at 3 months.
  
  
  RESULTS
  Perception of wives' support predicted increased adherence only in patients with high disease severity. Collaboration increased following nights with lower adherence and greater CPAP problems. Patients with lower conflict in the relationship reported a greater increase in collaboration associated with CPAP problems. Patients with lower support in the relationship reported increased next-day support following nights with CPAP problems. Perceived pressure from the wife was not associated with increased adherence in day-to-day analyses and associated with poorer adherence at 3 months.
  
  
  CONCLUSIONS
  The relationship between wives' involvement and adherence was bidirectional and influenced by disease and relationship context. The majority of findings demonstrated increased positive wife involvement as a reaction to adherence and problems with CPAP. Supportive and collaborative interventions have the potential to improve CPAP adherence and response to CPAP-related problems, particularly in patients with high disease severity. Pressure to use CPAP from the wife was not beneficial for adherence that day and predicted poorer adherence at 3 months. Further research is needed to test supportive spousal involvement as an adherence intervention.
authors.affiliation: Department of Neurology, Northwestern University, Chicago, IL, USA. k-baron@northwestern.edu
authors.forename: Kelly Glazer
authors.initials: KG
authors.lastname: Baron
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Smith
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Berg
authors.forename: Laura A
authors.initials: LA
authors.lastname: Czajkowski
authors.forename: Heather
authors.initials: H
authors.lastname: Gunn
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Jones
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D003299:Cooperative Behavior; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D020181:Sleep Apnea, Obstructive / Q000523:psychology* / Q000628:therapy*; D012944:Social Support; D018454:Spouses / Q000523:psychology*; D011795:Surveys and Questionnaires