Motivational Interviewing Effects on Positive Airway Pressure Therapy (PAP) Adherence: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Published in: Behavioral sleep medicine 2023-07, Vol.21 (4), p.460-487
• Main Authors: Crosby, Eric S., Spitzer, Elizabeth G., Kavookjian, Jan
• Format: Article
• Language: English
• Subjects: Adherence; Adult; Adults; Bias; Brief interventions; Clinical trials; Continuous Positive Airway Pressure; Humans; Interviews; Meta-analysis; Middle age; Middle Aged; Motivational Interviewing; Obstructive sleep apnea; Patient Compliance; Random effects; Randomized Controlled Trials as Topic; Sleep apnea; Sleep Apnea, Obstructive - therapy; Systematic review
• ISSN: 1540-2002; 1540-2010
• DOI: 10.1080/15402002.2022.2108033

This systematic review and meta-analysis examined Motivational Interviewing (MI) effects on positive airway pressure (PAP) adherence and related outcomes. Medline, CIHANL, Psych Info, Web of Science, PubMed, and Cochrane Database of Systematic Reviews were searched for randomized controlled trials published from peer-reviewed journals in English from 1990 to 2021 that compared objective PAP adherence among adults with obstructive sleep apnea (OSA) in a MI and non-MI intervention. A random effects meta-analysis model was completed at the 1-to-2-week, and 1-, 2-, 3-, and 12-month follow-up, and risk of bias was analyzed with the Cochrane Risk of Bias Tool. In 10 trials of naïve PAP users and one trial of non-naïve PAP users, 14 to 277 middle-aged adults with moderate-to-severe OSA generally engaged in a brief, individual, face-to-face, MI intervention with standard care or a control condition. Several trials of naïve PAP users demonstrated that MI increased PAP use 1-2.6 hours per night, but a similar number of trials showed comparable conditions. Secondary outcomes were mixed. Among non-naïve PAP users, MI did not significantly increase adherence or secondary outcomes. The meta-analysis of PAP-naïve participants revealed that MI had a small to moderate significant effect on PAP adherence at 1, 2, and 3 months after beginning PAP (Hedges' g = 0.38 to 0.48; 95% CI = 0.04, 0.75) compared to standard care alone. Despite heterogeneity, MI moderately increased PAP adherence among PAP-naïve adults with moderate-to-severe OSA, suggesting an effective strategy for short-term (1-3 months) adherence.