Specific insomnia symptoms and self-efficacy explain CPAP compliance in a sample of OSAS patients
Open accessAbstract
This study explores the association between specific insomnia symptoms (sleep onset, sleep maintenance and early morning awakenings symptoms) and self-efficacy (perceived self-confidence in the ability to use CPAP) with CPAP compliance in French patients with obstructive sleep apnea syndrome (OSAS). We performed a retrospective, cross-sectional analysis of CPAP compliance in a cohort of 404 patients diagnosed with OSAS. Patients completed mailed questionnaires on sleepiness (ESS), insomnia (ISI) and self-efficacy in sleep apnea (SEMSA). Linear regression modeling analyses were performed to explore the impact of measured variables on the number of hours of CPAP use. Of the initial pool of 404 patients, 288 returned the questionnaires (71% response rate). Their mean age was 63.16±12.73 yrs, 31% were females, mean BMI was 30.39±6.31 kg/m2, mean daily CPAP use was 6.19±2.03 h, mean number of years of use was 6.58±6.03 yrs, and mean initial AHI before CPAP use was 34.61±20.71 /h. Age (p<0.01), BMI (p<0.01), sleep onset insomnia symptoms (p<0.01), sleep maintenance insomnia symptoms (p<0.01) and self-efficacy (p<0.01) were significantly associated with mean daily CPAP use. We found that specific insomnia symptoms and self-efficacy were associated with CPAP compliance. Our findings underline the need to demonstrate that interventions that reduce insomnia symptoms and improve self-efficacy will increase CPAP compliance.
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A large number of case studies, pilot studies, chart-reviews, treatment trials, and cluster analyses have examined the effect of co-morbid insomnia symptoms on reduced CPAP outcomes in OSA patients.
“Since this time, a large number of case studies [69], pilot studies [70,71], chart-reviews [65,72], treatment trials [44,49,50], and cluster analyses [41,42] have examined the effect of co-morbid insomnia symptoms on reduced CPAP outcomes in OSA patients.”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [65]
The citation identifies this paper as a treatment trial, but Methods and materials > Participants describes its design as retrospective and cross-sectional. The Discussion also says that no causal inference can be made. Although the paper examines insomnia symptoms and CPAP compliance, it is not a treatment trial. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe ISI is a brief and valuable questionnaire measure of insomnia presence and severity, which has been utilized in several hundred insomnia treatment studies, including COMISA research.
“The ISI [54] is a brief, and valuable questionnaire measure of insomnia presence and severity, which has been utilized in several hundred insomnia treatment studies, including COMISA research [52,63,64,65].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [65]
The Methods and materials > Questionnaires section (page not provided) describes the ISI as a seven-item questionnaire that measures insomnia symptom severity and distinguishes levels of clinical insomnia. The paper uses it in an OSAS sample and discusses its use in COMISA research. It does not establish that the ISI has been used in several hundred insomnia treatment studies. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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- Authors
- Philip, P., Bioulac, S., Altena, E., Morin, C. M., Ghorayeb, I., Coste, O., Monteyrol, P.-J., & Micoulaud-Franchi, J.-A.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Institut Universitaire en Santé Mentale de Québec (CA)
- Centre Hospitalier Universitaire de Bordeaux (FR)
- Corresponding author
- Philip, Pierre
- Bioulac, Stéphanie
- Morin, Charles M.
- Ghorayeb, Imad
- Coste, Olivier
- Monteyrol, Pierre-Jean
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-04-04
- Volume
- 13
- Issue
- 4
- Pages
- e0195343
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5884569
- OpenAlex
- W2796056601
- Cited by
- 43
- References
- 49
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 5 · 2018: 2
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- The author(s) received no specific funding for this work
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- obstructive sleep apnea, CPAP adherence, insomnia symptoms, sleep onset insomnia, sleep maintenance insomnia, early morning awakening, self-efficacy, daytime sleepiness, body mass index
- MeSH terms
- Cross-Sectional Studies, Female, France, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Compliance, Surveys and Questionnaires, Retrospective Studies, Multivariate Analysis, Linear Models, Sleep Apnea, Obstructive, Self Efficacy, Continuous Positive Airway Pressure
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