title: Increasing adherence to obstructive sleep apnea treatment with a group social cognitive therapy treatment intervention: a randomized trial.
abstract: OBJECTIVE
  To examine whether a social cognitive therapy (SCT) intervention increases continuous positive airway pressure (CPAP) use compared to equivalent social interaction (SI) time.
  
  
  METHODS
  Individuals with obstructive sleep apnea (OSA) referred for CPAP therapy.
  
  
  METHODS
  Participants received a 30-min group education session regarding OSA and CPAP. Groups of three to four participants were then randomly assigned to an SCT session or social interaction.
  
  
  METHODS
  CPAP usage was assessed at 7 nights, then 1, 3, and 6 months. The two primary outcomes were adherence, usage ≥ 4 h per night at 6 months, and uptake of CPAP. Questionnaires were given pretreatment and posttreatment.
  
  
  RESULTS
  Two hundred six individuals were randomized to SI (n = 97) or SCT (n = 109). CPAP uptake was not different between groups (82% in SI, 88% in SCT groups, P = 0.35). There were no differences between groups in adherence: 63-66% at 1 week, and at 6 months 55-47% (P = 0.36). Higher pretreatment apnea-hypopnea index, higher baseline self-efficacy, and use of CPAP (≥ 4 h) at 1 week were independent predictors of CPAP adherence at 6 months. CPAP adherence increased by a factor of 1.8 (odds ratio = 1.8, 95% confidence interval 1.1-3.0) for every one-unit increase in self-efficacy. There was no difference between groups postintervention in self-efficacy scores, sleepiness, mood, or sleep quality.
  
  
  CONCLUSIONS
  In this randomized trial, a single SCT application did not increase adherence when compared with SI time. Although self-efficacy scores prior to CPAP predicted adherence, self-efficacy was not increased by the interventions. Increasing intensity and understanding of SCT interventions may be needed to improve CPAP adherence.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry, ACTRN12607000424404.
authors.affiliation: NHMRC Centre for Integrated Research in Understanding of Sleep (CIRUS), University of Sydney, Sydney, Australia ; Sleep and Circadian Research Group Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
authors.forename: Delwyn
authors.initials: D
authors.lastname: Bartlett
authors.forename: Keith
authors.initials: K
authors.lastname: Wong
authors.forename: Dianne
authors.initials: D
authors.lastname: Richards
authors.forename: Emma
authors.initials: E
authors.lastname: Moy
authors.forename: Colin A
authors.initials: CA
authors.lastname: Espie
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cistulli
authors.forename: Ronald
authors.initials: R
authors.lastname: Grunstein
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D045422:Continuous Positive Airway Pressure / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011615:Psychotherapy, Group / Q000379:methods*; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Continuous positive airway pressure; obstructive sleep apnea; patient adherence; self-efficacy