Peer support could help millions with sleep apnea slumber easier, study says

Continuous positive airway pressure, or CPAP, therapy can improve the lives of people with obstructive sleep apnea, but nearly half of adults with CPAP machines fail to adhere to a regular regimen of CPAP use. A new University of Arizona Health Sciences study published in the American Journal of Respiratory and Critical Care Medicine found that peer support improved CPAP adherence and patient satisfaction, which can improve sleep and overall health.

According to the National Council on Aging, 39 million U.S. adults have been diagnosed with obstructive sleep apnea, which is characterized by repeated episodes of upper airway collapse during sleep leading to fragmented sleep and reduced oxygen levels, as well as heart, kidney and metabolic health complications when left untreated. It is commonly treated with CPAP, which is associated with improvements in quality of life, hypertension, accidents and mortality. 

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“The CPAP is the gold standard treatment for patients with sleep apnea. But the problem is that it’s a complicated external device that requires willpower by patients to put it on their faces. It requires a behavioral change, and that keeps many people from using it,” said first author Sairam Parthasarathy, MD, director of the U of A Health Sciences Center for Sleep, Circadian and Neuroscience Research and professor and chief of the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the U of A College of Medicine – Tucson’s Department of Medicine. “Watching videos or reading instruction manuals only gets you so far. But peer-driven intervention puts a personal touch on showing patients how to use the machine. It helps those with sleep apnea demystify CPAP and use it to their advantage.”

Researchers enrolled 263 sleep apnea patients who were new to CPAP treatment in a six-month clinical trial. Participants were randomly divided into two groups. One group received usual care paired with educational materials. The other group interacted with trained peer mentors via in-person visits and phone calls.

The study found that 62% of study participants with sleep apnea who received peer support used the CPAP machine correctly and consistently, compared with 51% of those who only received educational materials. Participants in the peer intervention group averaged 4.5 hours of CPAP use per night, while those in the group without support averaged 3.7 hours.

Additionally, participants who received peer support reported they were significantly more satisfied with their CPAP-related support and believed their care was better coordinated than those in the control group did.

The peer support system trained people with sleep apnea who use CPAP to support people with obstructive sleep apnea as they began using a CPAP device. Study participants interacted with their peer mentors during in-person visits and eight phone calls over the first four weeks, followed by six calls over the next two months.

The peer support system was supported by an automated interactive voice program that patients could use to get answers to questions without directly talking to their peer mentor.

The study highlights the cost-effective nature of the peer support system. By leveraging peer support and technology, the burden on health care providers is reduced while promoting better health outcomes. The study suggests that incorporating peer support interventions into health care reimbursement policies could result in broader implementation and benefit patients nationwide.

The approach could also be adapted for other chronic conditions requiring long-term patient management.

“Peer intervention is scalable and exportable,” Parthasarathy said. “It could help patients with diabetes, blood pressure or any other chronic condition that requires significant self-care. The ability to talk to a person who has been through the same struggle that you have and being able to interact with someone rather than being left to your own devices can make for a world of difference.”

Co-authors included Christopher Wendel, researcher at the U of A College of Medicine – Tucson’s Department of Medicine at the, Michael Grandner, PhD, director of the Sleep and Health Research Program at the College of Medicine – Tucson’s Department of Psychiatry, Patricia Haynes, PhD, associate professor at the Mel and Enid Zuckerman College of Public Health, Stefano Guerra, MD, PhD, professor of medicine at the College of Medicine – Tucson, Daniel Combs, MD, assistant professor of pediatrics at the College of Medicine – Tucson, and Stuart F. Quan, MD, professor emeritus at the College of Medicine – Tucson and the Gerald E. McGinnis Professor of Sleep Medicine at Harvard Medical School.