Pharmacotherapy for Obstructive Sleep Apnoea and Coupled Life: A Descriptive Phenomenological Study of a Complex Interaction
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Sampling
2.3. Structure of the Interviews
2.4. Data Analysis
2.5. Ethical Considerations
3. Results
3.1. Drug Therapy Helps the Couple’s Relationship
3.1.1. Drug Therapy and the Couple’s Quality of Life
“I was more serene, of course […] I was more serene to the rest of her sleep”.(Partner)
“The serenity of sleeping and also feeling a little bit more relaxed in his sleep”.(Partner)
“Yes, I was glad that he maybe didn’t use the CPAP, so he was moving better in bed. And obviously he is happier without CPAP”.(Partner)
3.1.2. Support during Drug Therapy
“[My partner] always agreed [to participate in the drug study]”.(Patient not-adherent)
“I was motivated, I was July and it was hot… it was very stressful for him. So, no, I kept telling him ‘come on, you will see we will have a result’. I motivated him a lot”.(Partner)
“I was the one who pushed him to go all the way. In the sense that the first visit he did to diagnose the OSA, that they put that monitoring [polysomnography] to keep in the house to see that the levels were right? I told him look you have to do something because apnoea is dangerous!”(Partner)
3.2. Motivation for Drug Therapy Outweighs Side Effects
3.2.1. Individual Responses to Drug Therapy
“Yes! Because the effects, if they are not, let’s say, permanent and always present, I think that over the time that one has it, he no longer even pays attention to it. It is important that you sleep well”.(Patient 1, not-adherent)
“Yes, I would definitely recommend it. I would take it too, because the side effects were almost zero for me, so definitely I take it!”(Patient OSA therapy naïve)
“I hardly ever had any effects, only one was the smell of the urine it was a bit strange”.(Patient OSA therapy naïve)
“He says that maybe these tablets also affect sex […] On the other hand, I told him “You don’t have to worry about this, the important thing is that you recover and you are well”.(Partner)
3.2.2. The Positive Reaction to Drug Therapy
“The first week I didn’t feel much effects, but over time was a little better [they both slept better and more] […] I felt quieter anyway”.(Partner)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Rundo, J.V. Obstructive Sleep Apnea Basics. Clevel. Clin. J. Med. 2019, 86, 2–9. [Google Scholar] [CrossRef] [PubMed]
- Bradley, T.D.; Floras, J.S. Obstructive Sleep Apnoea and Its Cardiovascular Consequences. Lancet 2009, 373, 82–93. [Google Scholar] [CrossRef]
- Lin, C.-H.; Perger, E.; Lyons, O.D. Obstructive Sleep Apnea and Chronic Kidney Disease. Curr. Opin. Pulm. Med. 2018, 24, 549–554. [Google Scholar] [CrossRef] [PubMed]
- Perger, E.; Mattaliano, P.; Lombardi, C. Menopause and Sleep Apnea. Maturitas 2019, 124, 35–38. [Google Scholar] [CrossRef] [PubMed]
- Tregear, S.; Reston, J.; Schoelles, K.; Phillips, B. Continuous Positive Airway Pressure Reduces Risk of Motor Vehicle Crash among Drivers with Obstructive Sleep Apnea: Systematic Review and Meta-Analysis. Sleep 2010, 33, 1373–1380. [Google Scholar] [CrossRef] [PubMed]
- Ayas, N.T.; Taylor, C.M.; Laher, I. Cardiovascular Consequences of Obstructive Sleep Apnea. Curr. Opin. Cardiol. 2016, 31, 599–605. [Google Scholar] [CrossRef] [PubMed]
- Taranto-Montemurro, L.; Messineo, L.; Perger, E.; Salameh, M.; Pini, L.; Corda, L.; Ferliga, M.; Tantucci, C. Cardiac Sympathetic Hyperactivity in Patients with Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea. COPD J. Chronic Obstr. Pulm. Dis. 2016, 13, 706–711. [Google Scholar] [CrossRef] [PubMed]
- Perger, E.; Jutant, E.-M.; Redolfi, S. Targeting Volume Overload and Overnight Rostral Fluid Shift: A New Perspective to Treat Sleep Apnea. Sleep Med. Rev. 2018, 42, 160–170. [Google Scholar] [CrossRef]
- Chang, H.; Chen, Y.; Du, J. Obstructive Sleep Apnea Treatment in Adults. Kaohsiung J. Med. Sci. 2020, 36, 7–12. [Google Scholar] [CrossRef] [PubMed]
- Mehrtash, M.; Bakker, J.P.; Ayas, N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 2019, 197, 115–121. [Google Scholar] [CrossRef] [PubMed]
- Labarca, G.; Saavedra, D.; Dreyse, J.; Jorquera, J.; Barbe, F. Efficacy of CPAP for Improvements in Sleepiness, Cognition, Mood, and Quality of Life in Elderly Patients With OSA. Chest 2020, 158, 751–764. [Google Scholar] [CrossRef] [PubMed]
- Sullivan, C.E.; Berthon-Jones, M.; Issa, F.G.; Eves, L. Reversal of Obstructive Sleep Apnoea by Continuous Positive Airway Pressure Applied through the Nares. Lancet 1981, 317, 862–865. [Google Scholar] [CrossRef]
- Gentina, T.; Bailly, S.; Jounieaux, F.; Verkindre, C.; Broussier, P.-M.; Guffroy, D.; Prigent, A.; Gres, J.-J.; Kabbani, J.; Kedziora, L.; et al. Marital Quality, Partner’s Engagement and Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea. Sleep Med. 2019, 55, 56–61. [Google Scholar] [CrossRef]
- Perger, E.; Lyons, O.D.; Inami, T.; Smith, S.; Floras, J.S.; Logan, A.G.; Bradley, T.D. Predictors of 1-Year Compliance with Adaptive Servoventilation in Patients with Heart Failure and Sleep Disordered Breathing: Preliminary Data from the ADVENT-HF Trial. Eur. Respir. J. 2019, 53, 1801626. [Google Scholar] [CrossRef] [PubMed]
- Rapelli, G.; Pietrabissa, G.; Manzoni, G.M.; Bastoni, I.; Scarpina, F.; Tovaglieri, I.; Perger, E.; Garbarino, S.; Fanari, P.; Lombardi, C.; et al. Improving CPAP Adherence in Adults with Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front. Psychol. 2021, 12, 3266. [Google Scholar] [CrossRef] [PubMed]
- Messineo, L.; Magri, R.; Corda, L.; Pini, L.; Taranto-Montemurro, L.; Tantucci, C. Phenotyping-Based Treatment Improves Obstructive Sleep Apnea Symptoms and Severity: A Pilot Study. Sleep Breath 2017, 21, 861–868. [Google Scholar] [CrossRef]
- Perger, E.; Taranto Montemurro, L.; Rosa, D.; Vicini, S.; Marconi, M.; Zanotti, L.; Meriggi, P.; Azarbarzin, A.; Sands, S.A.; Wellman, A.; et al. Reboxetine Plus Oxybutynin for OSA Treatment. Chest 2022, 161, 237–247. [Google Scholar] [CrossRef]
- Perger, E.; Taranto-Montemurro, L. Upper Airway Muscles: Influence on Obstructive Sleep Apnoea Pathophysiology and Pharmacological and Technical Treatment Options. Curr. Opin. Pulm. Med. 2021, 27, 505–513. [Google Scholar] [CrossRef]
- Taranto-Montemurro, L.; Messineo, L.; Sands, S.A.; Azarbarzin, A.; Marques, M.; Edwards, B.A.; Eckert, D.J.; White, D.P.; Wellman, A. The Combination of Atomoxetine and Oxybutynin Greatly Reduces Obstructive Sleep Apnea Severity. A Randomized, Placebo-Controlled, Double-Blind Crossover Trial. Am. J. Respir. Crit. Care Med. 2019, 199, 1267–1276. [Google Scholar] [CrossRef]
- Luyster, F.S. Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review. J. Clin. Sleep Med. 2017, 13, 467–477. [Google Scholar] [CrossRef] [Green Version]
- Rosa, D.; Amigoni, C.; Rimoldi, E.; Ripa, P.; Ligorio, A.; Fracchiolla, M.; Lombardi, C.; Parati, G.; Perger, E. Obstructive Sleep Apnea and Adherence to Continuous Positive Airway Pressure (CPAP) Treatment: Let’s Talk about Partners! Healthcare 2022, 10, 943. [Google Scholar] [CrossRef] [PubMed]
- Luyster, F.S.; Dunbar-Jacob, J.; Aloia, M.S.; Martire, L.M.; Buysse, D.J.; Strollo, P.J. Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis. Behav. Sleep Med. 2016, 14, 67–84. [Google Scholar] [CrossRef] [PubMed]
- Armeni, P.; Borsoi, L.; Costa, F.; Donin, G.; Gupta, A. Final Report Cost-of-Illness Study of Obstructive Sleep Apnea Syndrome (OSAS) in Italy 2019. 2019. Available online: https://cergas.unibocconi.eu/sites/default/files/files/Cost-of-illness-study-of-Obstructive-Sleep-Apnea-Syndrome-%2528OSAS%2529-in-Italy_Report%25281%2529.pdf (accessed on 1 August 2022).
- Broström, A.; Nilsen, P.; Johansson, P.; Ulander, M.; Strömberg, A.; Svanborg, E.; Fridlund, B. Putative Facilitators and Barriers for Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea Syndrome: A Qualitative Content Analysis. Sleep Med. 2010, 11, 126–130. [Google Scholar] [CrossRef] [PubMed]
- Willman, M.; Igelström, H.; Martin, C.; Åsenlöf, P. Experiences with CPAP Treatment in Patients with Obstructive Sleep Apnea Syndrome and Obesity. Adv. Physiother. 2012, 14, 166–174. [Google Scholar] [CrossRef]
- van Manen, M. Phenomenology of Practice: Meaning-Giving Methods in Phenomenological Research and Writing; Routledge: London, UK, 2016; ISBN 978-1-315-42265-7. [Google Scholar]
- Sundler, A.J.; Lindberg, E.; Nilsson, C.; Palmér, L. Qualitative Thematic Analysis Based on Descriptive Phenomenology. Nurs. Open 2019, 6, 733–739. [Google Scholar] [CrossRef]
- Archibald, M.M.; Ambagtsheer, R.C.; Casey, M.G.; Lawless, M. Using Zoom Videoconferencing for Qualitative Data Collection: Perceptions and Experiences of Researchers and Participants. Int. J. Qual. Methods 2019, 18, 1609406919874596. [Google Scholar] [CrossRef]
- Baron, K.G.; Gunn, H.E.; Czajkowski, L.A.; Smith, T.W.; Jones, C.R. Spousal Involvement in CPAP: Does Pressure Help? J. Clin. Sleep Med. 2012, 08, 147–153. [Google Scholar] [CrossRef]
- Ward, K.; Gott, M.; Hoare, K. Becoming a Team: Findings from a Grounded Theory Study about Living with CPAP. Collegian 2018, 25, 81–88. [Google Scholar] [CrossRef]
- Ye, L.; Antonelli, M.T.; Willis, D.G.; Kayser, K.; Malhotra, A.; Patel, S.R. Couples’ Experiences with Continuous Positive Airway Pressure Treatment: A Dyadic Perspective. Sleep Health 2017, 3, 362–367. [Google Scholar] [CrossRef]
- Dellafiore, F.; Rosa, D.; Pittella, F.; Caruso, M.P.; Allemano, M.; Caruso, R. The Impact of Type 2 Diabetes Diagnosis on Married Couples. J. Diabetes Nurs. 2018, 22. [Google Scholar]
- Cilluffo, S.; Bassola, B.; Lusignani, M. Mutuality in Motor Neuron Disease. J. Neurosci. Nurs. 2021, 53, 104–109. [Google Scholar] [CrossRef] [PubMed]
- Dellafiore, F.; Buck, H.G.; Pucciarelli, G.; Barbaranelli, C.; Paturzo, M.; Alvaro, R.; Vellone, E. Psychometric Characteristics of the Mutuality Scale in Heart Failure Patients and Caregivers. Heart Lung 2018, 47, 553–561. [Google Scholar] [CrossRef] [PubMed]
- Giordano, V.; Iovino, P.; Corvese, F.; Vellone, E.; Alvaro, R.; Villa, G. Caregiver Contribution to Self-care and Its Associated Variables among Caregivers of Ostomy Patients: Results of a Cross-sectional Study. J. Clin. Nurs. 2022, 31, 99–110. [Google Scholar] [CrossRef] [PubMed]
- Karlstedt, M.; Fereshtehnejad, S.M.; Winnberg, E.; Aarsland, D.; Lökk, J. Psychometric Properties of the Mutuality Scale in Swedish Dyads with Parkinson’s Disease. Acta Neurol. Scand. 2017, 136, 122–128. [Google Scholar] [CrossRef] [PubMed]
- Pucciarelli, G.; Buck, H.G.; Barbaranelli, C.; Savini, S.; Simeone, S.; Juarez-Vela, R.; Alvaro, R.; Vellone, E. Psychometric Characteristics of the Mutuality Scale in Stroke Patients and Caregivers. Gerontologist 2016, 56, e89–e98. [Google Scholar] [CrossRef] [PubMed]
- Mead, M.P.; Irish, L.A. Spousal Influence on CPAP Adherence: Applications of Health-Related Social Control. Soc. Personal. Psychol. Compass 2016, 10, 443–454. [Google Scholar] [CrossRef]
- Weaver, T.E.; Sawyer, A.M. Adherence to Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnoea: Implications for Future Interventions. Indian J. Med. Res. 2010, 131, 245–258. [Google Scholar]
- Gobbi, P.; Castoldi, M.G.; Alagna, R.A.; Brunoldi, A.; Pari, C.; Gallo, A.; Magri, M.; Marioni, L.; Muttillo, G.; Passoni, C.; et al. Validity of the Italian Code of Ethics for Everyday Nursing Practice. Nurs. Ethics 2018, 25, 906–917. [Google Scholar] [CrossRef]
- Manara, D.F.; Villa, G.; Moranda, D. In Search of Salience: Phenomenological Analysis of Moral Distress. Nurs. Philos. 2014, 15, 171–182. [Google Scholar] [CrossRef]
Patient (n = 10) | Partner (n = 6) | |
---|---|---|
Gender | ||
Female | 1 | 5 |
Male | 9 | 1 |
Age (mean, range) | 54.8 (43–62) | 58 (44–68) |
Country | ||
Italy | 10 | 6 |
Other | 0 | 1 |
Education | ||
Secondary school | 3 | 4 |
High school | 7 | 1 |
Bachelor’s degree | 1 | |
Marital status | ||
Married | 7 | 4 |
Living together | 2 | 1 |
Civil union | 1 | 1 |
Relationship | Gender | Age | OSA Treatment |
---|---|---|---|
Patient | Female | 61 | Not-adherent to CPAP |
Patient | Male | 62 | OSA therapy naïve |
Patient | Male | 55 | Not-adherent to CPAP |
Patient | Male | 55 | Not-adherent to CPAP |
Patient | Male | 54 | OSA therapy naïve |
Patient | Male | 62 | Not-adherent to CPAP |
Patient | Male | 60 | OSA therapy naïve |
Patient | Male | 48 | OSA therapy naïve |
Patient | Male | 46 | OSA therapy naïve |
Patient | Male | 43 | OSA therapy naïve |
Partner | Female | 56 | Unknow |
Partner | Male | 68 | Unknow |
Partner | Female | 60 | Unknow |
Partner | Female | 58 | Unknow |
Partner | Female | 44 | Unknow |
Partner | Female | 55 | Unknow |
Theme | Sub-Themes | Patient’s Quotations | Partner’s Quotations |
---|---|---|---|
| 1.1 Drug therapy and the couple’s quality of life | “The use of drug therapy has also helped my partner sleep well and as a result has positively affected tour life as a couple”. (Patient 1, not-adherent) | “Yes, relatively in the sense that… the first night obviously there was little sleep, however the fact that it was in the same bed…” (Partner) |
1.2 Support during drug therapy | “We had talked about it and since I agreed to do it, she did too. Jointly, we came to the decision to participate in the study in essence”. (Patient OSA therapy naïve) | “If for your own, good I said ‘do it because at least you get a good night’s sleep, first of all, and then let me get a good night’s sleep too because if not I’m really going to go off the deep end with you too”. (Partner) | |
| 2.1 Responses to drug therapy | “Always positive experience, except however one day, when I felt a sensation just of anxiety, then fortunately I didn’t feel any other strange sensations, and anyway at the level of sleep I always felt refreshed”. (Patient OSA therapy naïve) | “The first tablets he took results were not seen, because nothing had changed. So, we had anyway imagined that “if this is the therapy, it does not work”, but since there was also the placebo we said, “let’s go ahead and see how it turns out”. In fact, then with the second pill the results were seen, in short”. (Partner) |
2.2 The positive reaction to drug therapy | “Yes, I would definitely recommend it. I would take it too, I mean in the sense if I have to choose, and logically the side effects are the ones that I’ve tried that have basically been almost zero for me, definitely!” (Patient OSA therapy naïve) | “I have to say that [during the period of drug therapy] my husband has been pretty easy going”. (Partner) |
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Rosa, D.; Perger, E.; Villa, G.; Bonetti, L.; Storti, V.; Cartabia, E.; Ledonne, G.; Lombardi, C.; Beatrice, A.; Amigoni, C.; et al. Pharmacotherapy for Obstructive Sleep Apnoea and Coupled Life: A Descriptive Phenomenological Study of a Complex Interaction. Healthcare 2022, 10, 1859. https://doi.org/10.3390/healthcare10101859
Rosa D, Perger E, Villa G, Bonetti L, Storti V, Cartabia E, Ledonne G, Lombardi C, Beatrice A, Amigoni C, et al. Pharmacotherapy for Obstructive Sleep Apnoea and Coupled Life: A Descriptive Phenomenological Study of a Complex Interaction. Healthcare. 2022; 10(10):1859. https://doi.org/10.3390/healthcare10101859
Chicago/Turabian StyleRosa, Debora, Elisa Perger, Giulia Villa, Loris Bonetti, Valeria Storti, Elisa Cartabia, Giuseppina Ledonne, Carolina Lombardi, Albanesi Beatrice, Carla Amigoni, and et al. 2022. "Pharmacotherapy for Obstructive Sleep Apnoea and Coupled Life: A Descriptive Phenomenological Study of a Complex Interaction" Healthcare 10, no. 10: 1859. https://doi.org/10.3390/healthcare10101859