Developing of a web-based application to facilitate patient treatment adherence in individuals with sleep apnea treated with Continuous Positive Airway Pressure (CPAP) devices.

Medicine 2.0

Background: Obstructive sleep apnea (OSA) is an increasingly common sleep disorder in individuals whose airways obstruct and become frequently apneic during sleep. Persons diagnosed with OSA are at risk for serious health problems such as hypertension, stroke, and arrhythmias including daytime sleepiness and poor waking cognitive function that increases their risk for motor vehicle and work related accidents [1]. The most common treatment for OSA is the use of a Continuous Positive Airway Pressure (CPAP) device which serves as a pneumatic splint to keep the airway open. Many people have difficulties in adapting to the device, modifying their sleep routine, and thus discontinue the treatment. In a study of experiences of OSA patients in the first three months of CPAP use, researchers followed the patients by questioning and evaluating of the CPAP use which helped the patients understand the often subtle improvements in their symptoms of sleep deprivation which hampered motivation to adhere to treatment [2]. Another study documented the effectiveness of a CPAP support group in sharing difficulties, offering suggestions, and empowering patients to problem solve their difficulties [3] which suggest that social networks introduced in an online application would provide at-home support to improve adherence. Research indicates that education alone does not improve adherence rates; however, instituting cognitive behavioral therapy may be effective [4]. Therefore the chosen approach focuses on improving self efficacy (confidence), evaluation of barriers, and developing behavioral strategies strengthened by social support to improve adherence rates. Objective: The purpose of this paper is to discuss the steps in the development of a web-based interactive application to facilitate patients' adherence to CPAP treatment. The goal of the web- based application is to facilitate adherence by creating a patient-managed tracking system for symptoms and CPAP usage, self-assessment of barriers, motivational interactive questioning, and a resource library including patient success stories. This application will facilitate developing behavioral strategies to promote adherence that can be accessed early in the treatment phase, when risk of non-adherence is high. Method: Application of Self Efficacy theory [5] to interactive web based design. Results: The CPAP motivational application will provide a web-based interactive patient self- management program that will: 1.) Capture user data by collecting self-reported CPAP use survey data; 2.) Track patient progress over time; 3.) Provide automated motivators; 4.) Provide a resource library with motivational success stories; and 5.) patient discussion forum. Conclusions: Use of theory based behavior modification approaches can in integrated into a web based application for future intervention study to test feasibility and efficacy. References: 1. Young T, Peppard P, Gottlieb D. Epidemiology of obstructive sleep apnea. A population health perspective. Am J Respir Crit Care Med 2002; 165:1217-39. 2. Dickerson SS, Akhu-Zaheya L.Longitudinal study of CPAP patients beginning treatment. Rehabil Nurs 2007;.32(6):241-50 3. Dickerson SS, Kennedy M. Seeking encouragement in a support group of individuals with sleep apnea who use continuous positive airway pressure (CPAP) devices. Rehabil Nurs 2006; 31(3),114-122. 4. Haniffa M, Lasserson TJ, Smith I. Interventions to improve compliance with continuous positive airway pressure for obstructive sleep apnoea. Cochrane Database of Systematic Review 2004 Issue 4. Article no CD003531.DOI:10.1002/14651858.CD003431.pub2. 5. Bandura A. Self Efficacy: The exercise of control 1997; NY:W. H. Freeman