0532 Mindfulness-based Stress Reduction For Claustrophobia Associated With Positive Airway Pressure In Obstructive Sleep Apnea

Abstract

Introduction: Claustrophobia is common in PAP users. No systematically evaluated interventions for PAP-associated claustrophobia exist. Aim: determine effect size of mindfulness-based stress reduction for claustrophobia (MBSR-C) on claustrophobia severity, frequency and PAP use. Methods: In a pilot trial we enrolled adults with OSA, PAP treatment ≤3mos with claustrophobia and compared outcomes between MBSR-C (n=12) and waitlist control (WL; n=10). MBSR-C included 8-weekly group sessions delivered by experienced MBSR interventionist. Outcomes at 1-wk (O1) and 4-wk (O2) post-exposure/wait. Primary outcome: VAS score claustrophobia severity; secondary outcome: discrete VAS score claustrophobia frequency; tertiary outcome: objective PAP use. Analyses: within- group change scores (95%CI; baseline-O2) for primary/secondary outcomes; between-group difference in change scores (95%CI); Hedge's g effect size. PAP use group differences using Fisher's Exact test/Wilcoxon two-sample test. Spearman correlation for claustrophobia change score and PAP use. Results: 22 OSA adults (M 48yrs; 9 males [40.9%]; AHI M 27.4 events/hr) were enrolled. Participants were sleepy (ESS M 10.0), had clinically-significant insomnia (ISI M 16.5), and claustrophobia (CLQ-R total score M 67.5). Only baseline anxiety (BAI) distinguished groups (p=0.04). Significant difference in average change claustrophobia severity between MBSR-C and WL (-47.3 [95%CI -77.4, -17.1], 14.5 [95%CI -21.1, 50.2], respectively; p=0.017); large effect size (Hedge's g, corrected=1.6). Significant difference in average change claustrophobia frequency between MBSR-C and WL (-1.57 [95% CI -2.33, -0.81]; 0.50 [95%CI -0.40, 1.40], respectively; p=0.004); large effect size (Hedge's g, corrected=2.1). MBSR-C and WL PAP use, ≥2hr/night at O2, was different (45.5% vs 0%, respectively; p=0.04) but no differences for PAP use ≥4hr/night at O2 (27.3% vs 0%, respectively; p=0.22). Median PAP use at O1 between groups was not different (p=0.07). In MBSR-C, claustrophobia severity change score was positively correlated with PAP use at O2 (r=0.37; 95%CI -0.63, 0.91); in WL, a large negative correlation was identified (r=-0.72; 95%CI -0.99, 0.78). Conclusion: MBSR-C decreased severity and frequency of claustrophobia and improved PAP use in claustrophobic PAP users. Larger fully-powered RCT with appropriate control comparison is indicated.