Vigilance as an Influential Factor of Continuous Positive Airway Pressure (CPAP) Adherence among Adults with OSA

Open Access
Author:
Criste, Taylor Joseph
Area of Honors:
Nursing
Degree:
Bachelor of Science
Document Type:
Thesis
Thesis Supervisors:
  • Amy M Sawyer, Thesis Supervisor
  • Harleah Graham Buck, Honors Advisor
Keywords:
  • Obstructive Sleep Apnea
  • Continuous Positive Airway Pressure
  • Vigilance
  • Cognition
  • Neurobehavior
Abstract:
Background: Obstructive sleep apnea (OSA) affects 18 million adults with higher prevalence among adults with obesity, diabetes, hypertension, and craniofacial abnormalities. Adherence to continuous positive airway pressure (CPAP) is a significant problem with 50% of users being nonadherent. Prefrontal specific-cognitive impairments, such as vigilance, have been identified among adults with OSA, but have never been investigated as an influential factor on adherence. Vigilance, or the ability to be attentive, may influence patients’ ability to regularly use CPAP and manage treatment. Preliminary evidence suggests self-reported vigilance impairment, measured by FOSQ, is a risk factor for CPAP use ≤ 2hrs/night in a significant model of nonadherence risk. This study aims to: (1) determine if there is impairment in vigilance among newly diagnosed adults with OSA prior to starting CPAP treatment, (2) determine if there is an improvement in vigilance among recently diagnosed adults with OSA after receiving three months of CPAP treatment, and (3) define the relationship between change in vigilance and CPAP use in CPAP-treated adults with OSA. Theoretical Framework: The Adapted Prefrontal Model suggests sleep disruption and intermittent hypoxia result in disruption of restorative sleep and cellular/chemical homeostasis generating cognitive executive system dysfunction, which may affect CPAP adherence. Methods: A randomized, double-blind, controlled study of 60 adults with newly diagnosed OSA is the source of data for this exploratory analysis. Inclusion criteria are: newly diagnosed with OSA (apnea hypopnea index (AHI) ≥10 events/hr), CPAP-naïve, ≥18 years of age, and able to read/speak English. A ten-minute psychomotor vigilance task test (PVT) was conducted before treatment exposure and after three-months CPAP treatment. Objective CPAP use (mean hrs/night at effective pressure) was extracted from CPAP devices. Data analysis includes descriptive statistics, dependent t-tests for paired samples, and regression analysis. Results: The sample with complete data for the exploratory analysis (n=32) included primarily middle-aged (52.81±11.29) men (75.0%) with severe OSA (AHI: 39.45 ± 23.43). Our sample only demonstrated one significant impaired vigilance metrics at baseline (number of lapses); no other metrics showed impairments in vigilance at baseline compared to a healthy control group. A significant improvement in vigilance was discovered in terms of change in both 1/RT and slowest 10% 1/RT after three months CPAP use. The change in vigilance over the three months was strongly correlated with one week CPAP use. Finally, we discovered baseline vigilance measures were not significant predictors of three-month CPAP use. Conclusion: Research suggests that approximately half of the OSA population does not demonstrate impaired vigilance; therefore, it is possible that our sample was part of the 50% without impairments. The reciprocal transform of RT improved after three months CPAP use, providing evidence that the reciprocal transform may be a highly sensitive measure of treatment response in sleep apnea. We found a significant relationship between change in vigilance and CPAP use at one week, suggesting that change in vigilance may be important during the first week of CPAP use. We did not find significant differences between baseline vigilance measures to be predictors of three-month CPAP use when stratified among disease severity (AHI and oxygen desaturation). Future research is needed further clarify the relationship between vigilance and CPAP use. It is important to identify and understand this relationship to provide evidence to support designing, tailoring, and sensitizing adherence interventions to cognitive impairments in the OSA population.