The Effect Of Nursing Intervention On Compliance With Continuous Positive Airway Pressure

Objective1 To assess the CPAP compliance in OSAHS patients and find out the influence factors of CPAP compliance.2 To test and verify the positive effect of the music therapy and relax training, as well as strengthening the health education (HE) and follow-up on the compliance with CPAP therapy, quality of life (QOL) and BP in the early morning in the OSAHS patients.Method1 The OSAHS patients had experienced CPAP titrations from 2009.Oct to 2010.Oct were enrolled. The patients were interviewed by telephone and were asked to assess their CPAP use time. Those who said their CPAP use time was less than 4 h/d for5 day/week were questioned about their reasons for noncompliance. We use logistic regression analysis to identify the factors affecting the CPAP compliance.2.45 patients who accepted titration and were willing to accept home therapy from 2009.10 to 2010.10 in our tab were randomly assigned into experimental and control group. Control group received oral HE and were interviewed in months 1,3 and 6. The experimental group received relaxation training and listened light music at the titration night to help patients to fall asleep with CPAP. Besides, each one would get a light music CD and a manual about OSAHS and CPAP on the morning after titration and early telephone support at weeks 1,2 and 3 in addition to the intervention the control group received.Result1193 patients participated in our survey.51.81% were still using CPAP; 15.03% had abandoned CPAP; 33.16% had never commenced it. The most common reasons cited for the poor compliance were they can't adapt to the CPAP in the titration night, they didn't perceive the need or the benefits of the treatment or found it troublesome. AHI (P=0.013) were identified as the influencing factor of CPAP compliance.2 In 1st month, CPAP usage was 4.67±0.53 VS 6.32±0.73 h/night in the control and experimental groups, respectively (P＜0.05). In 3rd month,3.97±0.38 h/d VS 6.19±0.63 h/night (P<0.05). In 6th month,3.49±0.36 VS 6.31±0.45 h/night (P＜0.05).3 The differences in each dimensionality and total score of QSQ of pre- and post-intervention between the control and trial group were as follow:daytime sleepiness 0.69±0.49 VS 1.60±0.46 (P＜0.05); diurnal symptoms0.50±0.62VS 1.24±0.66 (P＜0.05); nocturnal symptoms 0.89±0.48VS 1.96±0.53 (P＜0.05); emotions 0.30±0.77 VS 0.66±0.52 (P=0.77); social interactions 0.34±0.75 VS 0.88±0.55 (P=0.10) total score 0.58±0.33 VS 1.42±0.30 (P＜0.05).419 and 17 patients with hypertension were respectively in control and in experimental group. The differences of SBP and DBP of pre- and post-intervention between the two groups were 1.33±3.95 VS 6.07±1.79 mmHg (P＜0.05),2.51±4.96 VS 11.01±4.25mmHg (P＜0.05).Conclusion1 The CPAP compliance is poor. To improve the CPAP compliance, the medical staff should try to help patients to adapt to CPAP in the patients'first experience with CPAP and strengthen early HE and follow-up.2 Music therapy and relaxing training can relieve the nervous feeling to make them easily to adapt to CPAP. So it can be tried to be applied in the titration night and following treatment. Strengthening HE, telephone review and follow-ups, especially in the early time, can improve the compliance.3 The intervention can improve the QOL, social interactions, nocturnal symptoms, daytime sleepiness and other diurnal symptoms. It also can reduce the BP in early morning. We hope our intervention can be applied in clinical practice.4 The measuring method of CPAP usage is not objective enough. We hope the further study choose a more objective method to measure CPAP usage.