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Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study

Objectives Continuous positive airway pressure (CPAP) therapy has been demonstrated to effectively reverse the abnormal physiology of sleep apnea and improve a variety of patient outcomes, yet helping patients adapt and adhere to CPAP has proven to be a challenging issue in the effective treatment o...

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Autores principales: Miech, Edward J, Bravata, Dawn M, Yaggi, H. Klar, Austin, Charles, Tobias, Lauren A, Ferguson, Jared, Matthias, Marianne S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464984/
https://www.ncbi.nlm.nih.gov/pubmed/31019856
http://dx.doi.org/10.7759/cureus.4078
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author Miech, Edward J
Bravata, Dawn M
Yaggi, H. Klar
Austin, Charles
Tobias, Lauren A
Ferguson, Jared
Matthias, Marianne S
author_facet Miech, Edward J
Bravata, Dawn M
Yaggi, H. Klar
Austin, Charles
Tobias, Lauren A
Ferguson, Jared
Matthias, Marianne S
author_sort Miech, Edward J
collection PubMed
description Objectives Continuous positive airway pressure (CPAP) therapy has been demonstrated to effectively reverse the abnormal physiology of sleep apnea and improve a variety of patient outcomes, yet helping patients adapt and adhere to CPAP has proven to be a challenging issue in the effective treatment of obstructive sleep apnea (OSA). As a home-based intervention trial, the “Sleep Apnea in Transient Ischemic Attack and Stroke: Reducing Cardiovascular Risk with Positive Airway Pressure” (“sleep tight”) study was uniquely positioned to capture and evaluate challenges faced by patients over time during their introduction to CPAP therapy.  Methods A comparative case study design was used to better understand the process whereby patients adapted CPAP therapy in order to fit their own personal set of circumstances. Cases were identified from patients enrolled in the “enhanced intervention” group of the sleep tight trial.  Results These comparative case studies illustrated how adherence to CPAP therapy is an adaptive process where personal context matters. The case studies also demonstrated how some patients overcame challenges and barriers by themselves to integrate CPAP therapy into their own lives, while others required help from study staff to overcome these barriers and some were never able to successfully adapt CPAP therapy in order to fit their personal contexts, despite study staffs’ best efforts.  Conclusions A major opportunity to improve CPAP adherence appears to exist in placing greater emphasis on supporting patients in adapting CPAP therapy for “where they live.” 
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spelling pubmed-64649842019-04-24 Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study Miech, Edward J Bravata, Dawn M Yaggi, H. Klar Austin, Charles Tobias, Lauren A Ferguson, Jared Matthias, Marianne S Cureus Internal Medicine Objectives Continuous positive airway pressure (CPAP) therapy has been demonstrated to effectively reverse the abnormal physiology of sleep apnea and improve a variety of patient outcomes, yet helping patients adapt and adhere to CPAP has proven to be a challenging issue in the effective treatment of obstructive sleep apnea (OSA). As a home-based intervention trial, the “Sleep Apnea in Transient Ischemic Attack and Stroke: Reducing Cardiovascular Risk with Positive Airway Pressure” (“sleep tight”) study was uniquely positioned to capture and evaluate challenges faced by patients over time during their introduction to CPAP therapy.  Methods A comparative case study design was used to better understand the process whereby patients adapted CPAP therapy in order to fit their own personal set of circumstances. Cases were identified from patients enrolled in the “enhanced intervention” group of the sleep tight trial.  Results These comparative case studies illustrated how adherence to CPAP therapy is an adaptive process where personal context matters. The case studies also demonstrated how some patients overcame challenges and barriers by themselves to integrate CPAP therapy into their own lives, while others required help from study staff to overcome these barriers and some were never able to successfully adapt CPAP therapy in order to fit their personal contexts, despite study staffs’ best efforts.  Conclusions A major opportunity to improve CPAP adherence appears to exist in placing greater emphasis on supporting patients in adapting CPAP therapy for “where they live.”  Cureus 2019-02-15 /pmc/articles/PMC6464984/ /pubmed/31019856 http://dx.doi.org/10.7759/cureus.4078 Text en Copyright © 2019, Miech et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Miech, Edward J
Bravata, Dawn M
Yaggi, H. Klar
Austin, Charles
Tobias, Lauren A
Ferguson, Jared
Matthias, Marianne S
Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study
title Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study
title_full Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study
title_fullStr Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study
title_full_unstemmed Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study
title_short Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study
title_sort adapting continuous positive airway pressure therapy to where patients live: a comparative case study
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464984/
https://www.ncbi.nlm.nih.gov/pubmed/31019856
http://dx.doi.org/10.7759/cureus.4078
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