Treatment Compliance for Obstructive Sleep Apnea Syndrome
Requirements: as required
Treatment Compliance for Obstructive Sleep Apnea Syndrome
Richard Williams
National University
HCA 692
Professor: Joann Harper
07 August 2023
Table of Contents
INTRODUCTION 3
DESCRIPTION AND ANALYSIS OF OSAS 3
LITERATURE REVIEW 8
EXISTING TREATMENTS FOR OSAS 14
RESEARCH OF INTERVENTIONS TO INCREASE TREATMENT COMPLIANCE 17
DISCUSSION 24
LIMITATIONS 25
CONCLUSION 26
REFERENCES 28
Treatment Compliance for Obstructive Sleep Apnea Syndrome
Introduction
Obstructive sleep apnea syndrome (OSAS) is a sleep disorder affecting the quality of sleep and life for millions worldwide. The respiratory disorder occurs with the upper airways’ occlusion, causing ventilation interruptions. This causes oxygen desaturation, increased breathing effort, and sleep arousal (McNicholas & Pevernagie, 2022). This is associated with snoring, poor sleep patterns, and the consequences of lethargy and lack of adequate rest for the affected people. Research on OSAS has helped create an understanding of the condition and the mechanisms that cause upper airway occlusion and the pathophysiology and development of complications. This research has paved the way for the development of different treatments for OSAS. Patients suffering from sleep apnea are at an increased risk of hypertension, cardiovascular diseases and may be prone to road accidents. It is critical to ensure early detection of this condition since it will ensure better and more effective interventions. Despite increasing awareness concerning OSAS and its consequences, many patients remain undiagnosed and untreated. The implementation of various therapies has proven to be effective in treating this particular condition.
OSAS will occur due to various causes, and different risk factors may increase the likelihood of this condition. Excessive weight and obesity is a major causative factor for this condition. It is related to the soft tissue of the mouth and the throat. Many people who suffer from this condition are overweight or obese (McNicholas & Pevernagie, 2022). Other factors related to this condition are a narrow throat, a round head, hypothyroidism, rapid and excess growth due to hormones, allergies, and a deviated septum. People with conditions that congest the upper airways are also likely to suffer, as well as smokers and individuals who take alcohol. Occurrence of OSAS in children will often occur due to enlarged tonsils or adenoids and conditions such as a large overbite. Having Down’s syndrome is another huge risk factor for OSAS. Untreated OSAS can lead to serious complications such as cardiovascular disease, accidents, and premature death. It is believed that between 4% and 9% of middle-aged adults have sleep apnea. Among those who are aged 65 years, at least 10% suffer from the condition (McNicholas & Pevernagie, 2022). This is because aging will affect the brain’s ability to keep the upper airway throat muscles stiff during sleep, increasing the chances of narrowing or collapsing the airways. OSAS is four times as common in men as in women. However, women are more likely to suffer from this condition during pregnancy and after menopause. Other factors associated with obstructive sleep apnea include family history and ethnicity.
The most common symptom of OSAS is nighttime snoring. When accompanied by episodes of apnea, excessive daytime sleepiness, and arousal from sleep, snoring may be assessed as OSAS (McNicholas & Pevernagie, 2022). However, a diagnosis should be made using overnight polysomnography, which records nasal airflow, snoring sounds, oxygen saturation, and respiratory efforts, among other factors (Kapur et al., 2017). Apnea is the complete cessation of airflow for at least 10 seconds, and hypopnea is reduced airflow (McNicholas & Pevernagie, 2022). OSAS is a hypopnea/apnea disorder, and according to the American Academy of Sleep Medicine, it can be diagnosed when the apnea-hypopnea index (AHI) is more than five and accompanied by excessive daytime somnolence (Kapur et al., 2017). This must be differentiated from chronic snoring, whereby the latter is a person who always snores but whose AHI is less than 5.
The effects of OSAS have received a lot of attention from researchers. The most obvious effect is the quality of life that the individual with OSAS leads. Due to arousal from sleep and sleep interruptions, somnolence and daytime fatigue, and tiredness are common among people with OSAS (Vogler et al., 2023). This is mainly because frequent awakening makes restorative sleep challenging, and the individual may suffer from daytime drowsiness, fatigue, irritability, and trouble concentrating (Vanek et al., 2020). This has, in turn, been associated with a high risk of accidents due to a lack of alertness and reduced academic and work performance associated with poor concentration (Vogler et al., 2023). These effects make it necessary to provide treatment to enhance the quality of life for people with OSAS.
It is well established that untreated OSAS is a major determinant of cardiovascular morbidity. Epidemiological studies have established that 50% of people with OSAS also have hypertension, and more than 30% have OSAS (Brown et al., 2022). This indicates comorbidity, which increases the disease burden for the patients. While the causal link is unclear, some researchers have established that increased diastolic blood pressure is the first step in OSAS leading to hypertension (Cuspidi et al., 2019). In addition to hypertension, studies have established an increased risk of arrhythmias, type 2 diabetes, ischemic heart disease, and parthenogenesis, causing coronary artery disease in patients with uncontrolled OSAS (Arnaud et al., 2020). People with untreated OSAS have a higher mortality rate than the general population (Arnaud et al., 2020). Obesity is closely related to the development and severity of Obstructive Sleep Apnea Syndrome (OSAS). Studies have shown that people with obesity are more likely to be diagnosed with OSAS, and the increasing obesity pandemic has contributed to a rise in OSAS cases. Moreover, obesity can exacerbate OSAS and reduce the efficacy of certain treatments, such as Continuous Positive Airway Pressure (CPAP) therapy. Addressing the impact of obesity on OSAS treatment compliance and outcomes is crucial in developing effective interventions for managing the condition. These complications of OSAS present the need for treatment for all people with OSAS.
Sleep apnea is a growing public health problem. Among men, OSAS is diagnosed in approximately 13% of the population and 6% of the female population (Santili et al., 2021). However, it is estimated that more than 80% of sleep apnea cases are undiagnosed (Santili et al., 2021). People with obesity are also more likely to be diagnosed with OSAS than the general public (Lyons et al., 2020). Due to the increasing obesity pandemic in the past few decades, there has also been a sharp increase in OSAS cases, with the current estimates being 26% of Americans have OSAS (Lyons et al., 2020). These statistics indicate that the target issue is a priority in public health and must be addressed effectively. The most widely used treatment approach for OSAS is Continuous Positive Airway Pressure (CPAP). It is mostly used for moderate to severe OSAS treatment. This method provides pressurized air, which keeps the upper airway open to maintain patency during inspiration and expiration (Pavwoski & Shelgikar, 2017). An alternative to CPAP is an auto-titrating positive airway pressure (APAP) device. Unlike the CPAP, which provides a constant stream of pressurized air, the APAP will adjust the pressure of that air depending on the detected airway resistance (Johnson, 2022). Bi-level positive airway pressure (BPAP) is another option that provides a preset amount of pressure when breathing in and a different amount when breathing out (Johnson, 2022). CPAP is the most commonly used because it has been widely studied and determined to effectively control OSAS (Pavwoski & Shelgikar, 2017).
Alternatives to positive airway pressure treatment include oral devices, surgical interventions, and adjunct treatments. Oral devices are used to maintain upper airway patency and decrease the collapsibility of the airway (Tserenpil et al., 2020). Surgical interventions may include tissue removal, maxillomandibular advancement, and tracheostomy for other approaches that have failed and the patient is in a severe life-threatening condition (Tserenpil et al., 2020)). Adjunct treatment may include weight loss, repositioning, nasal expiratory positive airway pressure, and oral pressure therapy (Johnson, 2022). Each of these interventions is indicated depending on the severity of the patient’s condition and their tolerance and adherence to specific treatment options. The main challenge in OSAS treatment is that the response to treatment varies from one patient to another. For instance, Sánchez-de-la-Torre et al. (2015) found that while some patients significantly improve with CPAP, others do not, and clinicians cannot distinguish likely responders from non-responders beforehand. Other than failure to predict response to treatment, another challenge for CPAP and other treatments is some patients’ poor adherence and tolerance (Rapelli et al., 2021). Many patients may not adhere to treatment due to the discomfort associated with the devices, including oral devices. This creates a challenge in achieving the desired outcomes.
Moreover, despite relieving symptoms of OSAS, there is limited evidence that most treatments reduce cardiometabolic risks. CPAP, for instance, has been identified as having little efficacy in reducing cardiovascular and metabolic syndrome comorbidities (Randerath et al., 2018). OSAS has been associated with various health conditions, such as obesity, hypertension, type 2 diabetes, and cardiovascular diseases (Arnaud et al., 2020). Since OSAS often coexists with these conditions, addressing OSAS alone through CPAP therapy may not fully address the overall cardiometabolic risks posed by the comorbidities. Therefore, a comprehensive approach that targets both OSAS and its underlying comorbidities may be necessary to effectively reduce cardiometabolic risks in affected individuals. However, this is also closely associated with poor adherence and compliance with treatment (Rapelli et al., 2021). People with OSAS generally need better compliance and adherence to device-related treatment, which has led to a challenge in effectively managing the condition. Despite the extensive research on OSAS treatment, compliance with treatment remains the major challenge still being researched today. With the established poor compliance with the treatment of OSAS, researchers strive to create more effective treatment approaches and methods to increase adherence (Rapelli et al., 2021). The general problem of adherence to OSAS treatment has yet to receive adequate attention from researchers. Poor adherence to treatment means poor health outcomes and quality of life for people with OSAS. More specifically, there is a need for further research on the factors and interventions that affect adherence to OSAS treatment. To overcome this gap, this study will systematically review the literature to establish the factors affecting compliance with OSAS treatment in patients newly diagnosed with OSAS.
Literature Review
OSAS is a widespread sleep disorder affecting millions worldwide, characterized by repeated upper airway obstruction during sleep resulting in compromised ventilation, oxygen desaturation, and frequent awakenings. According to Veasey and Rosen (2019), many patients are usually unaware that their breathing has been affected and will not visit a physician for evaluation. Occurrences of sleep apnea are prevalent among 10% of men from 30-49 years of age and 9% among women, and 17% among men from 50-70 years of age. Obstructive sleep apnea is common, and it is an independent risk factor for motor vehicle accidents and cardiovascular disease (Veasey & Rosen, 2019). Obstructive sleep apnea is usually exhibited using symptoms such as loud snoring, excessive daytime sleepiness, depression, and irritability. In the long term, it is usually linked to obesity, high blood pressure, and an increased risk of heart attack or stroke. Occasional brief obstructive apnea events are usually harmless and common in adults. However, apnea episodes are usually considered significant when they last over 10 seconds each and five to seven times at night. Significant apnea usually occurs in 35% of habitual snorers (Veasey & Rosen, 2019). In apnea patients, episodes last 30 to 60 seconds or more of each. People suffering from this condition may spend over half of their sleep in total airway obstruction. This condition will lead to exaggerated breathing effort, which is in response to increased airway resistance and can cause repetitive arousals from sleep.
The clinical approach to patients with obstructive sleep apnea begins with assessing the likelihood of the disease and diagnosing coexisting conditions to direct diagnostic testing. The most effective therapy for reducing sleep apnea is positive airway pressure, usually applied with a tight seal to the nose or mouth (Veasey & Rosen, 2019). Continuous positive airway pressure provides constant positive pressure across inspiration and expiration. Surgical options for this therapy include radiofrequency reductive tongue and soft palate surgery. A newer option for treatment is hypoglossal-nerve stimulation; during sleep, the tongue is pushed forward, and the airways are opened (Veasey & Rosen, 2019). Weight loss is usually recommended for all overweight or obese patients with this condition. Therefore, this systematic literature review aims to identify factors impacting treatment compliance for newly-diagnosed OSAS patients and their interventions.
Elfeires et al. (2023) reveal that an important risk factor for OSA is the tongue, which has a high-fat content. The average percentage of tongue fat in individuals with OSA is slightly higher. The tongue has useful capacities to maintain the patency of the airways, and these are facilitated by the specific fiber compositions of its muscles. Increased intramuscular fat may change the tongue’s contractile force and shape, making it less effective as a muscle capable of dilating the pharynx. The tongue has useful abilities to maintain the airways’ patency, usually facilitated by specific fiber compositions of its muscles (Elfeires et al., 2023). Additionally, when there is increased tongue fat, this can impair muscle function and increase the tongue’s size and collapsibility. At the base of the tongue, where the tongue is attached to the bone by extrinsic muscles, there is a high proportion of fat in apneic persons. Each extrinsic muscle must be properly positioned away from the airway, which can lead to positive outcomes. It is also important to note that the link between obesity and OSAS may be impacted by an increase in both fatty and muscular tissue (Elfeires et al., 2023). Patients with OSAS will usually receive treatment using completion by lowering the size of the tongue, and tongue tissue should therefore be eliminated. A larger tongue with more fat is a major indicator of sleep apnea. Excessive fatty tissue in the head and neck also leads to sleep apnea.
The occurrence of sleep apnea is usually higher in the elderly population. This can be characterized by nocturnal episodes of obstruction in the upper airway, sleep fragmentations, and hypoxemia. Physiological and physical changes are often related to the quality of sleep, the quantity of sleep, and the architecture of sleep. Elderly individuals with OSAH usually demonstrate an impairment in physical and memory functions (Ernst et al., 2019). The occurrence of OSAH in elderly populations is also linked to negative outcomes, including stroke, hypertension, and even mortality. OSAH is also more likely to be ignored or bypassed by the aging population. This means treating this condition will be more difficult to diagnose and treat. Sleep apnea can occur at any age, but the risk is significantly higher in older people. As the human body weakens, the immunity to disease becomes less. One common occurrence in older people is weakened muscles and a more collapsible airway (Ernst et al., 2019). Additionally, the reflexes between the brain and the upper airway will not be as rapid and effective as in the past. Age-related weight gain is also common, leaving elderly individuals more vulnerable to sleep apnea. It is, therefore, important to be on the lookout for any symptoms in older people, such as loud or excessive snoring, difficulty sleeping, or a rapid decline in cognitive function.
For better outcomes, it is critical to carry out regular screening for sleep apnea in elderly individuals. Godoy et al. (2022) explain how polysomnography can be used to screen OSAS. Various screening tools can be used for patients, and these include the Berlin (BQ) tool, The STOP-Bang (S-Bang) questionnaire, and the Epworth Sleepiness Scale 9ESS). The BQ tool asks several questions, usually divided into three categories. The first category includes four questions about snoring and one concerning breathing pauses during sleep (Godoy et al., 2022). The second category includes questions about fatigue and tiredness and one concerning sleep during driving. The third category of questions concerns body mass index (BMI) and the presence of systemic arterial hypertension. Two or more positive categories in these questions can indicate a high risk of OSAH. The STOP-Bang questionnaire is another tool, and this is a method that is easy to execute. It is self-administered and consists of eight questions about snoring, daytime fatigue, apnea, SAH, BMI, neck circumference, age, and gender. The questions can be answered in a yes/no format, and at least three positive answers show a high risk of OSAH. The third screening tool is the ESS, and the tool includes observations that are related to nature as well as the occurrence of daytime sleepiness (Godoy et al., 2022). It is a self-administered questionnaire, and individuals will be required to rate the probability of napping or falling asleep in eight different situations, which are scaled on a rate of 0-3. Scores above ten will usually indicate a diagnosis of excessive daytime sleepiness. In these tools, the BQ reveals the best results in measures, specificity, predictive values, and LR in identifying OSAH.
It is critical to consider smoking as a major causative factor of sleep apnea. Smoking is a huge risk factor for the occurrence of respiratory conditions. It will usually worsen sleep quality due to the stimulation by nicotine and sudden nicotine withdrawal during sleep. It can therefore increase the severity of OSAH using alterations of the upper airway inflammation and neuromuscular function, as well as arousal mechanisms and sleep architecture (Zeng et al., 2023). Tobacco and other ingredients in cigarettes will usually comprise inhalants to which the upper airways may be exposed during smoking. Exposure to smoke can lead to narrowing of the upper airways and predispose to collapse and obstructive apneas. Nicotine can increase dopamine levels in the nucleus acumens (Zeng et al., 2023). The resultant increase in dopamine release can induce arousal and a reward sensation, leading to potential addiction. Hypoxia will impact the release of dopamine levels in the carotid body. There is limited information concerning the effect of smoking cessation on reducing these mechanisms. However, there is a clear connection between long-term smoking and increased OSAS.
Evidence also reveals that alcohol use may contribute to obstructive sleep apnea. It is important to consider the effects which alcohol has on the body and especially the airway. Alcohol also affects sleep patterns, the length of sleep, and how one breathes. Alcohol consumption relaxes the muscles in the airway, and at night, this can lead to obstructions in the upper airway and therefore cause sleep apnea. For people suffering from OSAS, the effects may become more serious with the consumption of alcohol (Sánchez-de-la-Torre et al., 2015). Alcohol may increase the time between when one stops breathing and continues breathing during sleep. It can also cause nasal congestion, making breathing harder through the nose. Yang et al. (2022) reveal that alcohol consumption is an independent risk factor for OSAS, and previous exposure also increases the risk as compared to no alcohol exposure at all. The mechanism of OSA induced by alcohol consumption is related to the upper airway collapse caused by alcohol consumption.
It is also important to note the connection between sleep apnea and hypertension. Many patients who suffer from OSAS also have hypertension. OSAS significantly increases the risk of hypertension. This is because consistent episodes of OSAS will produce surges in the systolic and diastolic pressure, which means that the blood pressure levels will be significantly elevated during the night. In healthy individuals, the blood pressure will lower by 10% and 20% at night (Sánchez-de-la-Torre et al., 2015). However, those with severe OSAS will experience dips in blood pressure of less than 10%. They will also experience a sudden and pronounced elevation of blood pressure when they wake up in the morning. OSAS is linked to sleep deprivation, which usually strains the heart. It will also lead to an over-activation of the nervous system, leading to high blood pressure. The sympathetic nervous system is important in triggering temporary physical reactions such as increased heart rate, high blood pressure, dilated pupils, and increased metabolism. In excess, this can lead to chronically elevated blood pressure (McNicholas & Pevernagie, 2022). When the individual with OSAS experiences collapses in the airway, the individual will stop breathing briefly. Their sympathetic nervous system will also activate, and blood levels will spike when they resume breathing. When the individual wakes up after an OSAS event, then the activation of the symptoms can be observed.
There is a major connection between sleep apnea and cardiovascular disease. This condition plays a major role in the deterioration of heart health because sleep apnea can increase the risk of cardiovascular disease. Sleep apnea can cause left ventricular diastolic dysfunction, significantly increasing the risk of heart failure (McNicholas & Pevernagie,2022). Several cardiovascular conditions may occur due to the presence of sleep apnea. This condition will lead to problems with heart rhythm, such as atrial fibrillation and bradycardia. Individuals with severe obstructive sleep apnea are four times more likely to suffer from those conditions than those without OSAS. People with obstructive sleep apnea are also likely to have coronary artery disease (McNicholas & Pevernagie, 2022). This happens when the arteries harden due to the narrowing of the small blood vessels supplying blood and oxygen to the heart. Those with severe OSAS are twice as likely to develop a heart attack in the future as those without the condition. OSAS leads to frequent pauses in breathing when one is asleep, which means that one stops breathing. These interruptions will lead to low levels of oxygen in the blood. When this happens, the heart will beat faster, and the blood pressure will escalate.
Existing Treatments for Obstructive Sleep Apnea Syndrome
Numerous options exist to treat Obstructive Sleep Apnea Syndrome (OSAS), each tailored specifically to meet each patient’s severity and individual characteristics. Continuous Positive Airway Pressure (CPAP), which uses pressurized air delivered through a mask to keep the upper airway open during inspiration and expiration (Pavwoski & Shelgikar, 2017), is the preferred treatment method. An alternate is Auto titrating Positive Airway Pressure (APAP), which adjusts airway pressure based on detected resistance. Furthermore, Bi-level Positive Airway Pressure (BPAP) provides different airway pressures for inhalation and exhalation (Johnson, 2022). Oral devices may help manage milder cases, or those who cannot tolerate CPAP; oral appliances maintain upper airway patency and minimize collapsibility (Tserenpil et al., 2020). Surgery may also be considered in certain instances: tissue removal, maxillomandibular advancement, or even tracheostomy may be considered if life-threatening conditions persist (Johnson, 2022, Tserenpil et al., 2020); additionally, adjunct treatments like weight loss; repositioning nasal expiratory positive airway pressure therapy can complement primary interventions (Johnson, 2022).
CPAP remains the principal treatment option due to its effectiveness in controlling OSAS (Pavwoski & Shelgikar, 2017). Treatment selection depends on several factors, including the severity of OSAS symptoms, patient preferences, and responses to therapy; selection should also consider each patient’s needs to optimize treatment outcomes and ensure compliance. As OSAS management advances, research and improvements must also occur to broaden treatment options and enhance patient outcomes. Understanding the factors affecting treatment compliance for Obstructive Sleep Apnea Syndrome (OSAS) is vital to enhance its management. Numerous studies have examined issues regarding patient adherence to various forms of OSAS treatments like CPAP. Capelli et al. (2021) conducted a scoping review of motivational interventions such as motivational interviewing and found it was effective at increasing CPAP adherence. Tailoring interventions specifically towards individual patient needs and preferences has also proven successful at increasing compliance with treatment.
Sanchez-de-la-Torre et al. (2015) conducted research assessing blood pressure response to CPAP treatment among OSAS and resistant hypertension patients, paying particular attention to treatment compliance. Those who consistently utilized CPAP therapy experienced improvements in controlling their blood pressure levels. CPAP treatment achieves this by altering plasma miRNAs and decreasing aldosterone-to-renin ratios. However, there is a need for a precise method that will help identify patients who are more likely to respond favorably to the treatment (Sanchez-de-la-Torre et al., 2015). Personal factors and device-related elements both play a part in treatment adherence. Patient comfort and usability are pivotal in accepting CPAP devices (Rapelli et al., 2021). New technologies like remote monitoring and mobile applications are introduced to facilitate treatment adherence (Rapelli et al., 2021). Patient education and support have long been key to increasing treatment compliance (Rapelli et al., 2021). Providing patients with accurate information regarding therapy benefits and the potential risks of non-adherence can profoundly affect patient behavior.
Upper-Air Stimulation Therapy is another common therapy for patients suffering from OSAS. It includes activation of the genioglossus muscles using stimulation of the hypoglossal nerve. The upper airway stimulation system usually consists of a small impulse generator implanted beneath the clavicle. This is a tunneled breathing sensing lead placed between the external and intercostal muscles and attached to the branch of the hypoglossal nerve that produces tongue protrusion (Heiser et al., 2021). When the sensing lead detects that inspiration is occurring, the impulse generator will send a signal via the stimulation lead to the hypoglossal nerve. This will result in a slightly forward displacement of the stiffened tongue. There are various prerequisites for the eligibility of this form of treatment. One must be older than 22 and have moderate to severe OSAS (This treatment is ineffective for mild OSAS) (Heiser et al., 2021). The individual should also have no pronounced upper airway anatomic abnormalities or significant comorbidities such as severe cardiopulmonary disease. After a month of device implantation, the patient returns for education and activation. The impulse generator will usually be controlled using a hand-held remote control. This treatment targets the breathing cycle and deals with losing upper airway muscle tone during sleep.
Another option for treating OSAS is Upper Jaw Advancement, also known as Maxillomandibular Advancement. It is a skeletal surgery that is used for the treatment of OSAS. The procedure is usually performed in adult patients who cannot tolerate CPAP. It involves opening the airway where it obstructs during periods of sleep, usually behind the soft palate and tongue (Zhou et al., 2022). Moving the upper and lower jaws forward using MMA can relieve these two points. The first part of the surgery involves submental intubation, and here, a breathing tube is passed from the mouth to under the chin using a small incision. The second part will involve placing heavy-duty braces or arch bars on the upper and lower teeth. The third part is upper jaw surgery, which uses an incision inside the upper lip to expose the upper jaw (Zhou et al., 2022). The fourth part is surgery of the lower jaw using an incision on the lower lip. Lastly, these incisions are closed with absorbable sutures, and a breathing tube is returned to the mouth. Finally, dental elastics will be placed on the arch bars to keep the bite the same.
Studies focusing on increasing treatment compliance for Obstructive Sleep Apnea Syndrome (OSAS) have generated an expansive body of research. Motivational strategies have become an important area of focus, with studies investigating their efficacy in increasing CPAP adherence (Rapelli et al., 2021). Adherence to continuous positive airway pressure (CPAP) is crucial for patients to fully realize this treatment’s therapeutic advantages. Nevertheless, several elements, like discomfort, adverse effects, and modifications to one’s lifestyle, frequently result in adherence rates that could be better. Non-adherence to CPAP therapy has been associated with heightened health hazards, diminished treatment effectiveness, and escalated healthcare expenditures. Hence, developing efficacious incentive tactics to augment adherence is of utmost importance. Motivational interviewing offers a patient-centric strategy that addresses individual barriers to compliance while creating intrinsic motivation toward treatment adherence (Rapelli et al.). Motivational Interviewing (MI) is a method that prioritizes the patient’s perspective and fosters collaboration to recognize and tackle personal obstacles to modifying behavior. The process encompasses the utilization of open-ended inquiries, reflective listening techniques, and affirmations to evoke intrinsic motivation among patients. Could you highlight how the mechanisms change the perception of the client or patient? (Kapur et al.,2017). How is intrinsic motivation triggered? Do you see that you describe what the provider does but not how it triggers motivation? It is acknowledged that patients are more likely to succeed in behavior modification when they perceive an authentic relationship with their healthcare provider.
Motivational interviewing can be used to enhance better outcomes for OSAS patients. The patients will be able to understand their role in treatment, leading to better outcomes (Rapelli et al., 2021). The patient can embrace behavioral change and enhance treatment acceptance through motivational interviewing. Additionally, it will ensure that the treatment is tailored to meet the needs of the patients. It will play a critical role in enhancing cooperation during treatment (Johnson, 2022). Any issues of concern will also be raised, and this will enhance the patient’s attitude toward the treatment which is received. Motivational interviewing can also help patients feel heard and understood, improving treatment satisfaction and quality of life. Motivational interviewing can address CPAP adherence issues such as discomfort and device adjustment. Clinicians can help patients overcome non-adherence by identifying the causes with them. Clinicians can help patients adjust their CPAP equipment or suggest other treatments if they can’t tolerate it. Addressing these hurdles may improve long-term treatment adherence.
Motivational interviewing can help OSAS patients with anxiety or sadness adhere to CPAP. These disorders are common in OSAS patients and may cause non-adherence. Clinicians can assist patients in overcoming ambivalence and sticking to therapy by employing motivational interviewing. Motivational interviewing can also help patients cope with mental health issues, improving their quality of life (Johnson, 2022). Motivational interviewing can also reduce CPAP-related social stigma. CPAP may make patients worry about their appearance or others’ opinions. Clinicians can use motivational interviewing to help patients grasp treatment advantages and the health risks of non-adherence. Motivational interviewing can also help patients find ways to cope with the social stigma of using CPAP, such as changing their perspective or finding assistance (Sánchez-de-la-Torre et al., 2015). Goal-setting and reinforcement can complement motivational interviewing. Goal-setting and support help patients develop realistic, achievable treatment adherence goals. Clinicians can help patients and improve treatment outcomes by combining these tactics.
Motivational interviewing helps patients overcome treatment non-adherence. Collaborative and empathic dialogue allows patients to evaluate their treatment adherence reasons and goals. This way, clinicians can help patients comprehend their illness and the need for medication adherence. Motivational interviewing can also help patients uncover internal motivation to stick with therapy, which lasts longer than extrinsic incentives. Goal-setting and reinforcement can boost treatment adherence (Rapelli et al., 2021). Goal-setting helps patients define manageable treatment adherence goals. Setting goals might help patients stick to treatment and track their success. Positive comments and rewards for goal achievement are reinforcement. Reinforcement can also help patients stick with therapy despite setbacks. Clinicians need special training to use motivational interviewing effectively.
Motivational interviewing is a sophisticated strategy that requires physicians to fully understand its concepts and how to implement them in clinical practice. Clinicians need training and supervision to reach this level. Motivational interviewing training usually includes didactic instruction, role-playing, and expert feedback. Didactic teaching teaches doctors motivational interviewing theory and practice (Rapelli et al., 2021). Clinicians can practice their abilities safely in role-playing exercises. Clinicians need skilled trainers to assess their motivational interviewing skills and develop them. Clinical treatment and feedback can also enhance motivational interviewing. Motivational interviewing clinicians should seek supervision and criticism from experienced trainers to improve their abilities and efficacy. Therapists should attend conferences and workshops to stay current on motivational interviewing research and best practices.
Customized treatment approaches have also proven their worth in improving compliance. Plans considering patient preferences and characteristics have yielded better treatment results (Sanchez-de-la-Torre et al., 2015), leading to higher patient engagement in care and satisfaction with regimens tailored specifically for individual patients. Technology has enhanced OSAS treatment. Remote monitoring systems can treat OSAS. These devices let doctors remotely monitor patients’ treatment adherence and give real-time feedback. Clinicians can use remote monitoring devices to track patients’ sleep habits, therapy efficacy, and problems. This information can help doctors tailor treatment plans to individual patients. Mobile apps track patient adherence and provide feedback. These apps can remind and track patients’ treatment equipment usage. Healthcare practitioners can use this information to ensure patients use their treatment devices as directed (Rapelli et al., 2021). Patients can also use mobile apps to learn about their health and treatment adherence through videos and articles. Technology, education, and support services improve treatment compliance. The benefits and risks of non-adherence can assist patients in grasping the treatment’s value. Patients who understand their disease and treatment adherence are more likely to comply. Thus, healthcare practitioners should educate patients about non-adherence risks and treatment advantages.
Positive patient behavior and development require ongoing assistance. Patients may encounter many barriers to CPAP adherence. Discomfort, difficulty adjusting, or forgetting to use the gadget can be hurdles. Healthcare practitioners can assist patients in overcoming these difficulties and succeed in therapy by giving continual support. CPAP machines may be too big or uncomfortable for some people. Providers can help patients with these concerns by providing other therapies or techniques to make the treatment device more comfortable (Rapelli et al., 2021). Oral appliances may help people who find CPAP machines uncomfortable. Alternatively, doctors can advise patients on adjusting their CPAP masks for comfort. Assisting patients in creating a treatment device habit can also give ongoing assistance. Setting a bedtime CPAP routine may help patients remember to use it. Healthcare providers can assist patients in developing appropriate sleep habits and motivate them (Rapelli et al., 2021). Healthcare practitioners can also assist patients in overcoming additional CPAP adherence obstacles. Patients may struggle to appreciate therapy benefits or feel ashamed of using CPAP machines. Healthcare practitioners can help patients comprehend treatment adherence and address worries or fears by educating and counseling them. Provide materials and tools to assist patients to track their progress and stay motivated. Healthcare practitioners may give patients a CPAP diary or smartphone app to measure therapy adherence and improvement. These techniques can boost patients’ confidence and treatment adherence.
Technology improves patient engagement and accountability. Telemedicine lets doctors consult with patients remotely. Patients don’t have to leave home to receive care. Telemedicine also helps doctors track patients’ progress and make therapy modifications. Sleep apnea treatment compliance depends on family and caregiver involvement. Family and caregivers can help patients stay to their treatment plan and overcome challenges (Rapelli et al., 2021). Family members and caregivers can assist patients in managing their conditions by working with them. Family and caregivers can assist patients in setting up and operating their therapy gadgets. This may include helping patients set up the device, checking its functionality, and reminding them to use it as prescribed. Family members and caregivers can assist patients in creating a treatment routine and using the device correctly by participating in this process. Sleep apnea patients may need emotional support from family and carers (Rapelli et al., 2021). This may include listening to patients’ worries, motivating them, and helping them stay positive and focused on their treatment goals. Family and caregivers can boost patient confidence and treatment adherence by giving emotional support. Family and caregivers can help patients overcome practical barriers to treatment adherence and emotional support.
Family and caregivers can also track patients’ progress and communicate with doctors. Family members and caregivers can help healthcare providers make treatment decisions and adapt plans by staying informed about patients’ treatment adherence and condition changes. Overall, technology has transformed obstructive sleep apnea syndrome treatment. Remote monitoring, mobile apps, and telemedicine have improved patient engagement and accountability and facilitated healthcare provider-patient contact. Education and support services help patients comprehend their disease and the need for treatment compliance. OSAS treatment should be patient-centered, with ongoing support and family and caregiver involvement. Clinicians can give customized care and help patients manage their conditions. Exploring novel technologies and approaches to improve OSAS treatment adherence remains exciting. Although technological solutions like remote monitoring and mobile apps have shown promise, more research needs to be conducted into their long-term effects on patient engagement and treatment outcomes. Healthcare practitioners must collaborate with patients to identify the best treatment plan and give the resources and support needed to follow it. Healthcare practitioners can use a patient-centered, evidence-based strategy to enhance OSAS management and results.
Telemonitoring is another important intervention that can enhance treatment compliance. This is especially because adherence to therapy is a major issue that therapists face, especially in treating OSAH. It will include the transmission of symptom scores and psychological data, including the patient’s heart rate, blood pressure, and oxygen saturation (Tamisier et al.,2020). The information will be transmitted using automated electronic means. The use of telemonitoring includes several innovative approaches which are designed to improve patient care. It includes different IT technologies such as telephone lines, broadband, or satellite. It incorporates electrocardiographic signals, which can be used to monitor body signals. The measurement uses a specific sensor to define the telemonitoring type (Tamisier et al.,2020). The telemonitoring systems will include a sensor, local data storage, centralized data storage, and an integrated diagnostic tool. The sensor includes a device that facilitates measuring body-related information, which is important in treatment decisions and monitoring of care progress. Examples are the ECG patch or blood pressure cuff. The local data storage will include a memory device which is a memory system implanted in the device. The centralized data storage will include a secure databank that allows the care provider to interrogate and analyze the measured and transmitted patient information. It also includes an integrated diagnostic tool that can measure information graphically over time. All these components will play a critical role in the telemonitoring device.
Treatment adherence is based on the need for agreement, especially since the patient should be free to decide whether or not to adhere to the doctor’s recommendation. Telemonitoring will enable early detection of any factors that may lead to non-adherence, ensuring easier and quicker resolution of these issues. It will also lead to better patient support in the patient-doctor relationship (Tamisier et al., 2020). The use of telemonitoring will ensure prioritization of follow-up appointments, and this will improve adherence early on when most of the gains have been made. This will allow filtering out of patients who are not using the technology and hence will gain no benefit from the treatment. It is also important to note that tee monitoring has an important role to play in other aspects of OSAH management, and this is other than follow-up (Tamisier et al., 2020), for example, in the diagnostic stage, where there is remote respiratory polygraphy and polysomnography. The use of telemonitoring will lead to improved adherence, and this will improve patient outcomes. Incorporation of telemonitoring in the follow-up of patients during CPAP therapy will widen access to this therapy. However, for those without access to technology, this may broaden the gap to treatment.
Discussion
Obstructive sleep apnea is a condition that is characterized by repeated episodes of complete or partial obstructions to the upper airway during sleep. This leads to increased resistance in the airways and respiratory efforts. This condition is more common in males as compared to women. It is a well-known risk factor for motor vehicle accidents and a decline in work performance (Arnaud et al., 2020). Obesity and weight-related lung function abnormalities are highly prevalent among patients suffering from OSAS. OSAS is a huge risk factor for cardiovascular disease and can be associated with increased cardiovascular morbidity and mortality. There are also links between OSAS and hypertension, as well as diabetes and other conditions. Diagnosing this condition uses polysomnography, a technical examination that monitors several physiologic parameters throughout the night as the patient sleeps. It will include recording the sleep stages using an electroencephalogram which can transmit information concerning eye movements and muscle tone. There are different forms of treatment for this condition. One is positive airway pressure which can provide pressure throughout the entire respiratory cycle (Arnaud et al., 2020). Treatment of OSAS will help to improve blood pressure and lead to better patient outcomes. Positional therapy is another treatment that enhances changes in the patient’s position during sleep. Currently, there are no proven effective medication options for treating this condition. Weight loss and exercise are usually recommended for patients with OSAS.
Although Obstructive Sleep Apnea Syndrome (OSAS) and its treatment have advanced considerably over time, there remain notable gaps in existing research that require attention. One such area is further examining factors influencing treatment adherence for OSAS; studies have investigated various interventions to increase it. However, limited knowledge remains regarding which factors impact response or compliance, specifically among individual patients or circumstances that influence treatment response (Rapelli et al., 2021). The more in-depth investigation should focus on uncovering individual patient needs, preferences, or barriers so tailored interventions can be created accordingly. Another limitation of the study is that research into the long-term effects of various treatments on cardiovascular and metabolic outcomes remains limited (Randerath et al., 2018). Therefore, continued investigation must occur into how effective different interventions are at mitigating OSAS-related comorbidities; such studies will shed valuable insights into the overall management of OSAS.
Another noted limitation in this study is the failure to inform the effectiveness and limitations of newer diagnostics for OSAS. The role of CPAP and other therapies in patients suffering from sleep deprivation is difficult to understand. Auto-adjustable CPAP is common, but this therapy has yet to be tested as rigorously as CPAP (Cuspidi et al., 2019). Another huge limitation is the need for more present literature to define pharmacotherapies’ role in treating obstructive sleep apnea. The studies must also explain the socioeconomic and racial disparities in diagnosing and treating OSAS and the clinical outcomes. Yet another limitation in the studies is that the diagnostic and therapeutic strategies which have been mentioned in the study have not managed to address the oxyhemoglobin desaturation and event duration among patients who have similar symptoms, as well as how this can address outcomes (Cuspidi et al., 2019). More data is needed to assess whether the effects of CPAP and other interventions may be useful predictors of their effects on cardiovascular outcomes. In the study, it is evident that more data is needed from long-term randomized controlled trials on the effects of treatment for obstructive sleep apnea. These will help better understand the extent and reversibility of cognitive impairments after initiating therapy.
Conclusion
In conclusion, OSAS treatment involves a multifaceted strategy. Motivational tactics, individualized approaches, technological integration, and patient education and support have improved treatment adherence and patient outcomes. However, more study is needed on medication compliance, newly diagnosed patients’ particular problems, and the long-term effects of medicines on cardiovascular and metabolic outcomes. Innovative technologies and treatments improve treatment adherence and patient-centered care. Healthcare practitioners must constantly investigate and deploy innovative OSAS management solutions to enhance patient outcomes. Researching tailored, motivational, and technology-integrated therapies may be necessary. It may also involve creating innovative tools to improve treatment adherence and patient-centered care. Healthcare practitioners must additionally treat OSAS symptoms, dangers, and repercussions, including cardiovascular and metabolic comorbidities. To ensure patient-centered, individualized treatment regimens, healthcare providers must collaborate with patients, families, and carers. Healthcare practitioners can enhance treatment adherence, risk mitigation, and quality of life for OSAS patients by addressing these research gaps and taking a complete approach to OSAS management. Providers can enhance OSAS patients’ quality of life by addressing these risks and problems. Healthcare providers must collaborate with patients, their families, and carers to customize treatment regimens. Finally, healthcare providers must continue to learn about OSAS management research and best practices. Healthcare professionals can optimize OSAS management and patient outcomes by working together.
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