Faculty Proceedings, Presentations, Speeches and Lectures


The Influence of Pre-Treatment Health Beliefs on the Trajectory of Pap Use during the First 12 Weeks of Treatment

Event Location / Date(s)

Boston, Massachusetts

Document Type


Presentation Date


Conference Name / Publication Title

31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS)


Introduction: Data are equivocal on whether pre-treatment health beliefs (Risk Perception [RP], Outcome Expectancies [OE], and SelfEfficacy [SE]) about obstructive sleep apnea (OSA) and positive airway pressure (PAP) predict treatment adherence. However, limited research has examined the association of these health beliefs on the trajectory of PAP use. Our aim was to determine if pre-treatment RP, OE, and SE influenced the trajectory of PAP adherence in US veterans.

Methods: Consecutive PAP-naïve OSA patients (n=185, 94% men, 42% black) attended the Miami VA sleep clinic to receive PAP and complete baseline questionnaires. Social cognitions about OSA and PAP were assessed with the Self-Efficacy Measure for Sleep Apnea (SEMSA). Patients returned for follow-up and adherence download. Outcomes were weekly averages of PAP use (mins). Models were fitted for the initial 12 weeks of treatment and time-centered at week 1. We used longitudinal multi-level modeling to characterize the influence of RP, OE, and SE on the trajectory of this outcome. Models were adjusted for relevant covariates (age, race, apnea-hypopnea index, sleepiness, insomnia, depression, and prescribed pressure).

Results: During initial use (at week 1), pre-treatment RP, OE, and SE were positively associated with more PAP use. A 1-point increase (on a 4-point scale) was associated with a 42min increase (p=0.04) in PAP use for RP (p=0.04), 62min increase in PAP use for OE (p<0.01), and 43min increase in PAP use for SE (p=0.02). A significant reduction in PAP use was observed over 12 weeks; However, neither RP, OE, or SE interacted with this reduction in PAP use.

Conclusion: These data demonstrate that lower scores on pre-treatment social cognitions predict worse PAP use during the first treatment week. Individuals’ PAP use declined in parallel regardless of pre-treatment health beliefs. Pre-treatment social cognitions about OSA and PAP can identify individuals for behavioral intervention before initiating PAP therapy to mitigate adherence decrements.