To assess the efficacy of motivational interviewing (MI) on improving automatic positive airway pressure (APAP) adherence in patients with obstructive sleep apnea (OSA).

OSA is a highly prevalent condition with negative impacts on long-term health in the general and military populations. APAP adherence is challenging and by Medicare standards, patients must use APAP at least four hours a night for 70% of nights to be compliant. At time of diagnosis patients attended a group OSA seminar. Current literature has shown that MI can be effective in improving APAP adherence. We aimed to increase our APAP adherence in newly diagnosed OSA patients by incorporating MI into our group OSA seminar.

A psychologist educated residents and fellows on MI techniques. The standard OSA seminar presentation was altered to include cues for presenters to ask MI questions. Pre- and post-MI questionnaires used a Likert scale to assess aspects of treatment. APAP adherence data was measured at follow-up. These data included: percentage used, average time used, and percentage used ≥4 hours. Seminar length was measured to determine any effects on presentation time as a balancing measure.

Under our non-MI care pathway, baseline APAP adherence was established at 29%. The MI-enhanced group OSA seminar was successfully implemented. Seminar length increased by an average of 6.4 minutes (37%). Subsequently, APAP adherence increased to 36.6%. Questionnaires had equivocal scores in all categories pre- and post-presentation for the MI and non-MI groups and indicated motivation to pursue therapy. Active-duty patients had more improvement from baseline.

Compared to baseline, overall APAP adherence increased by 26%. Implementing MI in a group setting was a feasible way to improve APAP adherence. Potential future Plan-Do-Study-Act cycles could include follow-up reminders on APAP adherence, continued training on MI techniques, and adjustment follow-up sheet to include adherence goals and troubleshooting tips.