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Factors influencing adherence to continuous positive airway pressure devices in individuals with spinal cord injury and sleep apnea: results of a qualitative study - 12/07/19

Doi : 10.1016/j.rehab.2019.06.009 
Clémence Bulteel, MD 1, Alice Le Bonniec, PsyD PhD 2, Marion Gounelle, PsyD 3, Annick Schifano, PsyD 3, Olivier Jonquet, MD 4, Arnaud Dupeyron, MD PhD 5, Isabelle Laffont, MD PhD 1, Florence Cousson-Gelie, PhD 2, Anthony Gelis, MD PhD 1, 3,
1 Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France 
2 Département Epidaure, Institut régional du Cancer Montpellier, 208, Avenue des Apothicaires, 34298, Montpellier, France, Univ Paul Valery Montpellier 3, Univ. Montpellier, Epsylon (EA4556), 34000 Montpellier, France 
3 Centre Mutualiste Neurologique Propara, 263, avenue du Caducée, 34090 Montpellier, France 
4 Service de Réanimation médicale et Grands brulés, Centre Hospitalo-Universitaire Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France 
5 Département de Médecine Physique et de Réadaptation, CHU Caremeau, Place du Pr Debré, 30000 Nîmes, France 

Corresponding author and reprint request sent to: Centre Mutualiste Neurologique Propara, 263 rue du Caducée, 34090 Montpellier, FranceCentre Mutualiste Neurologique Propara, 263 rue du CaducéeMontpellier34090France
Sous presse. Manuscrit accepté. Disponible en ligne depuis le vendredi 12 juillet 2019

Highlights

In individuals with spinal cord injury and sleep apnea (SA), some specific factors related to continuous positive airway pressure (CPAP) adherence include physical dependence on the CPAP device but also the burden of care for the living partner and impact on the relationship.
The perception of SA as a low-priority additional medical issue can explain in part adherence difficulties.
The CPAP device can be a barrier to social participation, when travelling, for example.
Physicians needs to be aware of these factors when caring for individuals with spinal cord injury and SA.

Le texte complet de cet article est disponible en PDF.

Abstract

Background: In individuals with spinal cord injury (SCI) and sleep apnea (SA), adherence to continuous positive airway pressure (CPAP) therapy seems unsatisfactory despite technical and educational support implemented when starting treatment.

Objective: We aimed to design comprehensive model of adherence to CPAP therapy in individuals with SCI and SA.

Methods: This was a prospective qualitative study based on semi-directed interviews and using the grounded theory as an analytic method. The theoretical framework was the social cognitive theory of Bandura. Participants were recruited from an SCI referral centre. Individuals with SCI using or having used a CPAP device for SA were included. Data were collected by semi-directed interviews on the experience of individuals with SCI regarding SA and being fitted with a CPAP device and were coded and organized into categories of experience and category relationships.

Results: Among the 17 individuals included; 9 had tetraplegia; the median age was 62 (Q1–Q3 47–66) years and median time since injury was 16 (Q1–Q3 1.75–21) years. Four categories of data were identified: 1) from symptoms to validation of SA diagnosis, 2) CPAP device fitting process, 3) representations of SA, and 4) level of adherence to the treatment. In addition to the factors already observed in the general population, the proposed model identified specific adherence factors in individuals with SCI, such as physical and relational dependence on a third party, increased daily care burden and increased presence of medical devices in the daily environment.

Conclusion: SA and its management present certain specificities in individuals with SCI that the physician must take into account to optimize therapeutic proposals, follow-up modalities and device adherence.

Le texte complet de cet article est disponible en PDF.

© 2019  Publié par Elsevier Masson SAS.
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