Tables
- Table 1
Summary of studies included in this review
Study Participants Intervention Methods Outcomes Olsen et al. [1] 1488 patients with OSA from various studies
1247 male
241 female
Age: 46–60 yearsAn overview of psychologically informed interventions for CPAP adherence
The HBM was used in prediction of both CPAP acceptance and adherenceModerated regression techniques Applying theoretical models to OSA research has substantially improved the understanding of psychological constructs in CPAP adherence
Using psychological and educational interventions for improving CPAP adherence is an understudied area of research; however, CBT-based interventions as well as motivational interventions addressing aspects of CPAP use are suggested as appropriate interventions for this populationWild et al. [2] 119 patients with OSAHS attending a sleep centre for overnight CPAP titration over an 8-month period
94 male
25 female
Age: mean 51 yearsPatients completed health value, health locus and self-efficacy prior to CPAP titration Three psychological measures were used in accordance with Wallston’s learning theory Objective adherence data measured using CPAP run-time clocks were collected
At 3-month follow-up, the mean CPAP use was 3.6±2.7 h per night in this population with 21 (18%) participants receiving some technical intervention for CPAP-related side-effectsBroström et al. [3] 247 patients recruited from a CPAP clinic with three 1-h visits over a period of 2 weeks
203 male
44 female
Age: mean 60 yearsSECI was posted to perceive the effects on CPAP adherence ESS, OSAS severity variable and objective adherences to CPAP treatment were obtained from the medical records Type D patients scored significantly higher (p<0.05–0.001) in 12 of the 15 side-effects compared with non-Type D patients
A total of 74 (30%) of the patients with OSAS (28% of the men versus 39% of the women) had Type D personalityBollig [5] Review of multiple studies Clinical status outcomes were collected both before and after 3 months of therapy with questionnaires ESS, MSLT and FOSQ Type D personality OSA patients reported a higher complaint of adverse effects from CPAP therapy and reported a higher rate of continued sleepiness than non-D personalities
In a discussion, 50% of patients with Type D personality used their CPAP <4 h per night, compared to 16% of the non-Type D participantsDieltjens et al. [6] 82 patients out of 113 with a known baseline type D scale started using MAD treatment between 2006/2009
58 male
24 female
Age: mean 50±1 years82 patients from 113 patients using MAD completed the DS14 Type D scale at baseline then follow up at 2 years SDB diagnosis started on a MAD device with demographic and clinical data including results from DS14, and a perceived side-effects and adherence postal questionnaire Characteristics of the 82 patients: BMI 27.9±4.3 kg·m−2; AHI 17±13 events per h; ESS 10±5; VAS 6±2
Of the Type D patients, 45% discontinued MAD treatment with 15% of non-Type D reported treatment discontinuationMoran et al. [4] 63 participants diagnosed with OSAHS, with CPAP for 30 days, usage defined as >4 h per night on 70% of nights
31 male
32 female
Age: mean 57.1 yearsPredictors of adherence were identified including demographic variables and personality traits Mini-IPIP, BIS/BAS and WAYS On ratings from the BIS/BAS, a raised BIS was a strong predictor of nonadherence (r= −0.452, p<0.01), followed by neuroticism
An elevated BIS score and neuroticism may indicate that personality factors are important in the determination of adherence to CPAPEkici et al. [11] The MMPI was used for 94 treatment-naïve snorers and OSA people
All patients with OSA and snorers were accepted with SDB (AHI >0 events per h)
The threshold of 5 events per h sleep was chosen to define both OSA and snorersAdmitted for overnight PSG with questionnaires PSG, MMPI, Fatigue scale, Adult ADHD scale, ESS, and SF-36 OSA patients scored significantly higher on Hs scale (65.0±12.0 versus 58.4±7.9, p=0.01)
OSA patients compared to snorers have significantly higher rate of clinical elevation on both Pd (13.0 versus 0%, p=0.03) and Hs (26.1 versus 3.3%, p=0.01)
The results of the study may indicate that patients with OSAS, compared to snorers, presented with more Hs and Pd personality characteristicsHayashida et al. [12] 230 patients referred with OSAS with AHI >5 events per h; given CPAP
230 male
Age: 20–73 yearsESS, MMPI, SDS, age, BMI, sleep duration during the preceding month and AHI Single and multiple linear regression analyses were performed to estimate the association between the ESS and the other measures tested Age had negative association with ESS score (r= −0.245, p<0.001)
BMI (r=0.165, p=0.012), AHI (r=0.199, p=0.002), SDS (r=0.169, p=0.010), Hs (r=0.212, p=0.001), Hy (r=0.177, p=0.007), Pd (r=0.133, p=0.044), Pt (r=0.227, p=0.001), Sc (r=0.228, p<0.001) and Ma (r=0.163, p=0.014) all had a positive association with ESS score
There were several statistically clear and significant correlations (r≥0.5) among many MMPI variables:
Hs versus D
Hy, Pd, Pt and Sc
D versus Pt, Sc and Si
Hy versus Pd and Pt
Pd versus Pt and Sc
Pt versus ScMols and Denollet [9] 2813 patients total from 12 studies
Exclusion from the search included any cardiovascular population and any study with a negative affectivity or social inhibition personality10-item standardised checklist for pre-defined criteria for systematic review on published papers A cross-sectional design analysing Type D personality amongst non-cardiovascular patient population in a medical population Patients with sleep apnoea on treatment reported more side-effects of treatment and were less likely to adhere to treatment than their non-type counterparts (p<0.05–0.001)
Type D patients experienced their condition to be more disabling compared to non-Type D patients (40.5 versus 26.4; p=0.015), especially emotionally (p=0.007) and functionally (p=0.033)Pierobon et al. [13] 157 patients with OSAS from an obese population
106 male
51 female
Age: 47±11.9 yearsCBA 2.0, neuropsychological assessment, WAIS-R, verbal span test and PSG Cross-sectional study
Patients were assessed using both psychological and neuropsychological variantsPatients reported with higher frequency, compared to the normal distribution, the presence of an extrovert personality trait and depressive behaviours: 15.9% of the patients minimised symptoms and denied distress, whereas 28.0% presented psychological disorders
Compared to the normative group, patients’ results were characterised as impaired with a higher percentage in short-term verbal memory (30.6%) and in short-term visual spatial memory (20.5%)
Moreover, 30.6% of patients were impaired in one cognitive function, 11.5% in two, 8.9% in three, and 8.2% in four or more cognitive functions
No significant relationships between psychological–neuropsychological data and clinical variables emergedSo et al. [14] 88 patients with UARS.
45 male
43 female
Age: 36.84±13.85 years
365 patients with OSAS
299 male
66 female
Age: 49.52±11.79 yearsAIS, PSQI and ESS Overnight PSG, AIS, PSQI, SCL-90-R and EPQ The URAS group scored significantly higher than the OSA group on the ESS, AIS and PSQI (p<0.001)
Scores of all SCL-90-R subscales in the UARS group were significantly higher than those in the OSA group (all were p<0.001, except somatisation, which was p=0.016)
Patients with UARS also scored lower on the EPQ-E (p=0.006) and EPQ-L (p<0.001), and showed higher scores on EPQ-P (p=0.002) and EPQ-N (neuroticism) (p<0.001) than those with OSA/OSAS
The ESS scores for UARS and OSAS were 10.2 and 6.8 (p<0.001)
Patients with UARS are more likely to have neurotic personalities and tend to be more anxious and sensitive than patients with OSAS (psychoticism 2.97±2.37 versus 2.14±1.76, neuroticism 16.57±4.46 versus 13.10±4.89)Ayow et al. [15] 8 patients recruited from a multisite sleep clinic, 4 who used CPAP for >5 h for 7 nights and 4 <1 h for 7 nights
4 male
4 female
Age: 20–73 yearsDemographic data, severity of OSA, extent of CPAP use, use of prescribed adjunct sedatives/hypnotics, and selected comorbidities known to influence CPAP adherence Semistructured interviews took place in a private office in the clinic and lasted approximately 15–60 min
Questions asked about CPAP experience, CPAP use, influences for CPAP use/nonuse and biggest challenge for CPAP usePerceived physical, psychological and social factors were found to influence both CPAP use and non-use
The way patients feel about themselves influences the ways in which they manage their OSA with or without CPAPHBM: Health Belief Model; CBT: cognitive behavioural therapy; OSHAS: obstructive sleep apnoea–hypopnoea syndrome; SECI: Side-Effects of CPAP Inventory; ESS: Epworth Sleepiness Scale; OSAS: obstructive sleep apnoea syndrome; MSLT: Multiple Sleep Latency Test; FOSQ: Functional Outcomes of Sleep Questionnaire; MAD: mandibular advancement device; SDB: sleep disordered breathing; VAS: visual analogue scale for snoring; IPIP: International Personality Item Pool; BIS/BAS: behavioural inhibition system/behavioural activation system; WAYS: Ways of Coping; PSG: polysomnography; ADHD: attention deficit/hyperactivity disorder; SF-36: 36-item Short Form Survey; Hs: hypochondriasis; Pd: psychopathic deviate; SDS: Self-Rating Depression Scale; Hy: hysteria; Pt: psychasthenia; Sc: schizophrenia; Ma: hypomania; D: depression; Si: social introversion; CBA: Cognitive Behavioural Assessment; WAIS-R: Wechsler Adult Intelligence Scale Revised; UARS: upper airway resistance syndrome; AIS: Athens Insomnia Scale: PSQI: Pittsburgh Sleep Quality Index; SCL-90-R: Symptom Checklist-90 Revision; EPQ: Eysenck Personality Questionnaire; E: extroversion/introversion; L: lie; P: psychoticism; N: neuroticism.
- Table 2
Personality tests used in this review
Test What it measures Test information MMPI [11, 12] Personality characteristics on 10 clinical scales:
Hypochondriasis
Depression
Hysteria
Psychopathic deviate
Masculinity/femininity
Paranoia
Psychasthenia
Schizophrenia
Hypomania
Social introversion567 items
True/falseBIS/BAS [7] Appetite and aversive motives BAS regulates appetitive motives, moves toward something desired, sensitive to reward and escape from punishment, and associated with positive affect and optimism
BIS regulates aversive motives, moves away from something aversive, sensitive to punishment and nonreward, and related to fear and anxietyDS14 and DS16 [4, 6, 13] Type D personality DS14 contains 14 items and a 5-point Likert-type scale ranging from 0 (false) to 4 (true) is used to measure the subjects’ personalities
DS16 contains 8 items with negative affectivity and 8 items about social inhibition answered with a 5-point Likert rating scale.The Big Five [7] Five main domains of personality (OCEAN) 50 questions to rate on how true they are about the person on a 5-point Likert-scale (1, disagree; 3, neutral; 5, agree) NEO-FFI [13] Five main domains of personality (OCEAN) 60 questions assessing the essentials of personality Mini-IPIP [7] Five main domains of personality (OCEAN) 20 questions containing 4 items for each of the Big Five traits indicating the degree the statement applies to them on a 5-point scale DOCCO [7] Stress, personality and lifestyle 200 questions CBA [14] State and trait anxiety, personality characteristics, psychophysiological disorders, fears and phobias, and depressive behaviours Includes an anamnestic schedule providing information on habits, personal history, sleep, eating behaviour, work, etc. WAYS [7] Different domains or aspects of personality, including basic descriptive traits, motivation and coping skills 66 items to measure thoughts and actions used in stressful situations
Measures 8 coping factors:
confrontive coping
distancing
self-controlling
seeking social support
accepting responsibility
escape avoidance
planful problem solving
positive reappraisalSCL-90-R [16] Psychiatric symptoms Multidimensional, self-report symptom inventory consisting of 90 items divided into 9 symptom dimensions:
somatisation
obsessive–compulsive
interpersonal sensitivity
depression
anxiety
hostility
phobic anxiety
paranoid ideation
psychoticismEPQ [16] Personality traits measuring psychoticism, neuroticism, extraversion and lying 4-item measures of psychoticism (social psychopath, solitary, troublesome, cruel and inhumane traits), neuroticism (anxious, worrying, moody and frequently depressed), extraversion (sociable, craves excitement, carefree and optimistic) and lying (social desirability) NEO-FFI: NEO Five Factor Inventory; IPIP: International Personality Item Pool; CBA: Cognitive Behavioural Assessment; WAYS: Ways of Coping; SCL-90-R: Symptom Checklist-90 Revision; OCEAN: openness, conscientiousness, extroversion, agreeableness and neuroticism.