The prevalence of sleep-disordered breathing is high, with an apnea-hypopnea index of
over 15 per hour found in 49.7% of men and 23.4% of women in the general population (1).
The gold standard treatment for sleep-disordered breathing is continuous positive airway
pressure (CPAP) therapy (2). However, nearly 30% of patients are considered non-adherent
to CPAP treatment (3). Moreover, the number of hours of CPAP usage has been shown to be
directly associated with a reduction in objective and subjective sleepiness, and
improvement in daytime functioning (4). A recent prospective study conducted in a French
clinical population cohort of 5138 participants found an effect of CPAP treatment
duration on reducing the risk of developing a major cardiovascular event (stroke,
myocardial infarction, all-cause mortality) (5). Therefore, the poor adherence to CPAP
treatment represents a public health challenge for healthcare professionals managing
these patients. Several predictors for non-adherence can be identified, such as using
CPAP for less than 4 hours per night during the initial treatment phase, moderate to
severe obstructive sleep apnea, or low self-esteem (6). Measures aimed at promoting
patient adaptation from the initiation of treatment are crucial as this period determines
long-term adherence to CPAP therapy (7). Among these measures, there is the management of
"physical" adverse effects such as xerostomia (using a humidifier), feeling too much or
too little air (modifying CPAP pressure profiles), skin problems, and mask air leaks
(interface adjustment), which are well-known and applied by health care organization
providing the CPAP machines (2).
On top of these "technical" problems, patients related issues such as mask-induced
anxiety, psychosocial conditions, and dysfunctional thoughts about CPAP treatment may
prevent patients from using their CPAP properly. Innovative tools such as psycho corporal
therapies, including medical hypnosis, could be used in these situations. A recent
literature review focusing on the impact of medical hypnosis on sleep disorders in adult
patients found an improvement in various sleep parameters (sleep quality, insomnia
complaints, frequency and/or intensity of parasomnias) in 58.4% of patients. However, in
this systematic review of 24 studies, none of them explored the use of medical hypnosis
in sleep-related breathing disorders (8).
Hypnosis can be defined as an altered state of consciousness in which a person's
attention is detached from their immediate environment and absorbed in inner experiences
such as feelings, cognition, and imagery (9). Hypnotic induction involves focusing
attention and imaginative involvement to the point where what is imagined seems real. By
using and accepting suggestions, the clinician and the patient create a benevolent
hypnotic reality with the goal of improving the patient's clinical situation (10).
In the literature, there is only one clinical case report describing a benefit of medical
hypnosis for CPAP tolerance in a child with cherubism (a rare fibro-osseous genetic
disease-causing nasal obstruction). In this case, CPAP therapy using an oral interface
was fully accepted after three hypnosis sessions and corrected the obstructive sleep
breathing disorder (11). In a slightly different domain, there is a case report of
successful use of medical hypnosis as an adjunct therapy for weaning from mechanical
ventilation (12).
Our hypothesis is that the use of medical hypnosis in CPAP-treated patients could improve
the patient's perception of the treatment, making it more positive. Medical hypnosis
could occur very early in the management process, with rapid learning of self-hypnosis to
actively influence this crucial period for long term adherence of CPAP. The principal
objective is therefore to evaluate the effects of medical hypnosis on adherence to CPAP
therapy in patients with sleep-disordered breathing.