PREDICTING TREATMENT ADHERENCE FROM ELECTROPHYSIOLOGICAL BIOMARKERS AND INDIVIDUAL DIFFERENCES IN BEHAVORIAL ACTIVATION (BAS) AND BEHAVIORAL INHIBITION (BIS) SYSTEMS

Abstract

Obstructive sleep apnea (OSA) is a common chronic sleep disorder with a demanding and complex treatment regimen. Even though continuous positive airway pressure (CPAP) is a highly effective treatment for OSA, approximately 25% of those prescribed CPAP do not adhere. In accordance with a recent call for a biopsychosocial approach to address CPAP nonadherence, two studies were designed to investigate patient-centered factors of nonadherence. Study One was a laboratory-based experimental study with the aim to identify predictive variables of behavioral intentions to adhere to advantage- and disadvantage-framed health messages, which simulated receiving an OSA diagnosis and subsequent CPAP treatment recommendations. Multiple regression models indicated that higher behavioral intentions after viewing the advantage-framed message were expected from undergraduate participants endorsing higher positive emotional responses from the message and lower use of humor as a coping strategy. Higher behavioral intentions after viewing the disadvantage-framed health message were expected from undergraduate participants endorsing higher feelings of control, greater relative right hemisphere baseline cortical activity, higher levels of behavioral inhibition, and lower use of humor as a coping strategy. Study Two was a community-based study that aimed to identify predictive variables of CPAP adherence in a clinical sample of adult patients with OSA. Logistic regression analyses were employed in accordance with current adherence criteria at seven, thirty, sixty, and ninety day time-points. Age significantly predicted nonadherence at sixty days, while age and subjective severity rating predicted nonadherence at ninety days. Multiple regression analyses were used to predict total hours of CPAP use at the same time-points, and were able to identify additional predictors with clinical utility. Age, race, and reward responsiveness trait were significant predictors of total hours of CPAP use at sixty days, while age and race were significant predictors at ninety days. Important clinical implications are discussed in light of findings for enhancing likelihood of CPAP adherence.