title: Integrating psychology and medicine in CPAP adherence--new concepts?
abstract: To date, continuous positive airway pressure (CPAP) is the most effective intervention in the treatment of obstructive sleep apnoea, but adherence to this treatment is often less than optimal. A variety of factors and interventions that influence and improve CPAP use have been examined. There is increasing recognition of the multifaceted nature of CPAP adherence: the patient's psychological profile and social environment have been recognised, in addition to the more extensively researched patient's treatment and physiological profile. Understanding how these multiple factors impact on CPAP use in an integrative fashion might provide us with a useful holistic model of CPAP adherence. This concept of integration--a biopsychosocial (BPS) approach to health and illness--has previously been described to understand care provision for various chronic health disorders. This paper proposes an adherence framework, whereby variables integrally affect CPAP use. The BPS model has been considered for nearly 35 years; the presence of poor CPAP adherence was acknowledged in the early 1990s--it is timely to incorporate this approach into our care pathway of CPAP users.
authors.affiliation: Rush University Medical Center, Chicago, IL, USA; NHMRC Centre for The Integrated Research and Understanding of Sleep (CIRUS) Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: megan_crawford@rush.edu.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Crawford
authors.affiliation: Nuffield Department of Clinical Neurosciences/Sleep & Circadian Neuroscience Institute, University of Oxford, UK; NHMRC Centre for The Integrated Research and Understanding of Sleep (CIRUS) Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Espie
authors.affiliation: Woolcock Institute of Medical Research, Sydney, Australia; NHMRC Centre for The Integrated Research and Understanding of Sleep (CIRUS) Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Delwyn J
authors.initials: DJ
authors.lastname: Bartlett
authors.affiliation: Woolcock Institute of Medical Research, Sydney, Australia; NHMRC Centre for The Integrated Research and Understanding of Sleep (CIRUS) Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Ron R
authors.initials: RR
authors.lastname: Grunstein
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D006801:Humans; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology*; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy
keywords: Adherence; Biopsychosocial model; Continuous positive airway pressure; Interaction