What was the research about?
Obstructive sleep apnea is a health problem that causes the throat muscles to relax and block the airway, making breathing stop and start during sleep. Continuous positive airway pressure, or CPAP, is a common treatment for sleep apnea. CPAP machines use an air hose and mask to give patients constant, steady air pressure while they sleep.
In this study, the research team tested a program in which trained peers helped patients who were starting treatment for sleep apnea. Peers were people who had sleep apnea, too, and used a CPAP machine regularly. The team compared patients who had peer support with those who didn’t. They looked at how satisfied patients were with their care and how often patients used their CPAP machines.
What were the results?
After six months, compared with patients who didn’t work with a peer, patients who had peer support
- Were more satisfied with the support they got from their sleep doctor and clinic
- Were happier with the coordination of their care
- Used their CPAP machines more often
Patients who did and didn’t have peer support reported similar overall experiences of care.
Who was in the study?
The study included 263 patients with sleep apnea who were about to start using a CPAP machine. Of these, 84 percent were white, 6 percent were African American, 2 percent were American Indian or Alaska Native, and 8 percent were another race. Patients received care at four sleep centers in in Tucson, Arizona. The average age was 49, and 53 percent were men.
What did the research team do?
The research team assigned patients by chance to one of two groups. The first group received six months of peer support. The second group received brochures and DVDs about sleep apnea and using CPAP machines.
In the peer support group, the research team trained peers to help patients based on the peers’ own experiences with CPAP machines. When possible, the research team matched peers and patients by age, gender, and other traits. For the first two months, peers and patients had 10 phone calls. Peers helped patients use the CPAP machines and prepare for doctors’ appointments. For the next four months, peers supported patients as needed. Patients used a special phone system to connect with their peers so they wouldn’t have to look up their phone numbers. The system also sent reminders about future peer meetings. The system connected to patients’ CPAP machines and sent data to the team about how often patients used their machines.
At the start of the study and six months later, patients filled out a survey about their CPAP use and how happy they were with their care.
Patients with sleep apnea, doctors, and sleep disorder professionals helped the research team develop the study.
What were the limits of the study?
Most patients in the study were white. The study took place in one city. Results might differ for people from other backgrounds or locations.
Future studies could look at patients from other backgrounds or locations.
How can people use the results?
Sleep centers can consider these results when deciding how best to support patients with sleep apnea.
To determine the effectiveness of a peer-driven intervention on improving patient satisfaction with continuous positive airway pressure (CPAP) therapy for treatment of obstructive sleep apnea (OSA) compared with educational materials
|Design||Randomized controlled trial|
|Population||263 patients with OSA who had not yet started treatment|
Primary: satisfaction with support of CPAP services
Secondary: patient assessment of chronic illness care, overall experience of care (using the CAHPS Health Plan 4.0 Survey), care coordination, CPAP adherence
|Timeframe||6-month follow up for primary outcome|
This randomized controlled trial compared the effectiveness of a peer intervention using an interactive voice response phone system (PDI-IVR) with educational materials on improving patient satisfaction with CPAP therapy for OSA and other outcomes.
The study included 263 patients with a new diagnosis of OSA who were starting CPAP therapy and receiving care at four sleep centers in Tucson, Arizona. Of these patients, 84% were white, 6% were African American, 2% were American Indian or Alaska Native, and 8% were another race. The average age was 49, and 53% were male.
Researchers randomized patients to one of two groups. The first group received six months of support from peers who had OSA and adhered to CPAP therapy. When possible, researchers matched patients and peers by age, gender, and other characteristics. In 10 interactions over a two-month period, peers shared coping strategies for and benefits of CPAP therapy. Peers and patients also discussed risks of untreated sleep apnea, ways to improve the effectiveness of the CPAP equipment and interface, and how to prepare for upcoming physician or respiratory therapist appointments. For another four months, patients could contact peers as needed.
To facilitate communication, patients and peers used PDI-IVR, an automated system that eliminates the need to exchange phone numbers and stores messages for users. PDI-IVR also sent reminders automatically to patients and peers about upcoming interactions. The system transmitted CPAP adherence information to researchers.
The second group received educational brochures and DVDs about CPAP therapy.
Patients in both groups received usual care and training from a respiratory therapist on the basics of caring for and operating CPAP equipment.
Researchers surveyed patients on outcomes at baseline and six months later. They assessed CPAP adherence from data transmitted by PDI-IVR.
Patients, providers, product makers, health insurers, policy makers, and representatives from public advocacy groups helped develop and conduct the study.
At six months, compared with patients who received educational materials, patients that used PDI-IVR had higher ratings of satisfaction with
- CPAP support services (p<0.001)
- Chronic illness care (p=0.008)
- Care coordination (p=0.03)
CPAP adherence was greater among patients who used PDI-IVR compared with patients who received educational materials (p<0.02).
The groups did not differ in patients’ overall rating of experience of care.
Most patients were white, and all were from one city. Results may differ for people from other backgrounds or locations.
Conclusions and Relevance
Patients with OSA who received six months of PDI-IVR were more satisfied with CPAP support services, chronic illness care, and care coordination and had better CPAP adherence than patients who received educational materials.
Future Research Needs
Future research could examine whether patients from different backgrounds or geographic regions have similar results to those in this study.
Final Research Report
View this project's final research report.
More to Explore...
Experiencing the Much-Needed Benefits of Sleep
Talking About Men's Health, March 20, 2019
In a contribution to the TAMH Blog, Dr. Parthasarathy highlights the importance of including patients in his project and how one of them proposed the idea for peer counseling to help people with sleep apnea and their use of a CPAP machine.
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Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- The reviewers found the report to be well written, of high scientific quality, and to have minimal limitations.
- Reviewers recommended that the researchers include a cost-benefit analysis of the peer intervention, as this would likely be important to providers and patients. This was not possible because of funding restrictions. However, the researchers included information on the amount of time peer buddies spent doing in-person visits and on telephone calls with clients. Researchers noted that this information would also be helpful for implementing the program in different settings.
- Reviewers asked whether the intervention addressed issues of sleep hygiene, particularly short sleep duration, as this was known to differ based on race, ethnicity, and socioeconomic status. Habitual short sleep duration could look like participants were not consistently using their continuous positive airway pressure machines, even when they were. The researchers acknowledged this issue and that they did not account for sleep duration in the intervention.
Study Registration Information
- Has Results