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OBJECTIVE: To examine whether a social cognitive therapy (SCT) intervention increases continuous positive airway pressure (CPAP) use compared to equivalent social interaction (SI) time. PARTICIPANTS: Individuals with obstructive sleep apnea (OSA) referred for CPAP therapy. INTERVENTION: Participants received a 30-min group education session regarding OSA and CPAP. Groups of three to four participants were then randomly assigned to an SCT session or social interaction. MEASUREMENTS: CPAP usage was assessed at 7 nights, then 1, 3, and 6 months. The two primary outcomes were adherence, usage ≥ 4 h per night at 6 months, and uptake of CPAP. Questionnaires were given pretreatment and posttreatment. RESULTS: Two hundred six individuals were randomized to SI (n = 97) or SCT (n = 109). CPAP uptake was not different between groups (82% in SI, 88% in SCT groups, P = 0.35). There were no differences between groups in adherence: 63-66% at 1 week, and at 6 months 55-47% (P = 0.36). Higher pretreatment apnea-hypopnea index, higher baseline self-efficacy, and use of CPAP (≥ 4 h) at 1 week were independent predictors of CPAP adherence at 6 months. CPAP adherence increased by a factor of 1.8 (odds ratio = 1.8, 95% confidence interval 1.1-3.0) for every one-unit increase in self-efficacy. There was no difference between groups postintervention in self-efficacy scores, sleepiness, mood, or sleep quality. CONCLUSIONS: In this randomized trial, a single SCT application did not increase adherence when compared with SI time. Although self-efficacy scores prior to CPAP predicted adherence, self-efficacy was not increased by the interventions. Increasing intensity and understanding of SCT interventions may be needed to improve CPAP adherence. CLINICAL TRIALS REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12607000424404.

Original publication




Journal article



Publication Date





1647 - 1654


Continuous positive airway pressure, obstructive sleep apnea, patient adherence, self-efficacy, Cognitive Therapy, Continuous Positive Airway Pressure, Female, Humans, Male, Middle Aged, Patient Compliance, Psychotherapy, Group, Single-Blind Method, Sleep Apnea, Obstructive, Surveys and Questionnaires