Diagnosis and Treatment of Sleep Apnea in Women Veterans

女性退伍军人睡眠呼吸暂停的诊断和治疗

• 批准号: 10300577
• 负责人: Jennifer L Martin
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10300577
• 关键词: Accounting; Address; Adherence; Adopted; Anxiety; Area; Behavioral; Cardiovascular Diseases; Caring; Cause of Death; Clinical Management; Clinical Trials; Cognitive Therapy; Data; Diagnosis; Disease; Drowsiness; Education; Fatigue; General Population; Goals; Health; Heart Diseases; Hour; Hypertension; Hypothyroidism; Intention; Intervention; Link; Literature; Measures; Mental Depression; Methods; Modeling; Monitor; Motivation; Outcome Study; Patient Education; Patient Self-Report; Patients; Population; Psychotherapy; Publishing; Quality of life; Randomized Controlled Trials; Recommendation; Reporting; Research; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep disturbances; Sleeplessness; Snoring; Statistical Methods; Techniques; Testing; Therapeutic; Veterans; Woman; Women' s Health; Work; adherence rate; adverse outcome; base; blood pressure reduction; depressive symptoms; design; diagnostic criteria; efficacy testing; evidence base; experience; functional disability; high risk; improved; learning strategy; men; mindfulness; mortality; mortality risk; novel; poor sleep; positive airway pressure; preference; programs; psychologic; reduce symptoms; sleep quality; social factors; therapy adherence; treatment as usual; vehicular accident

Sleep disordered breathing (SDB) is associated with significant adverse health consequences including cardiovascular disease, motor vehicle accidents, daytime functional impairments and mortality risk. Although SDB is more common among men than women, it still impacts 17% of women in the general population. [Our preliminary evidence suggests it is even more common among women Veterans who receive VA care.] The recommended first-line therapy for most patients with SDB is positive airway pressure therapy (PAP). Published studies show that women have lower PAP adherence than men, particularly in the US, yet we are not aware of data comparing men and women Veterans. Because women Veterans experience significant sleep disturbance and other consequences of sleep disorders, adjusting to PAP therapy may be quite difficult. To date, studies have not tested interventions specifically designed to improve PAP adherence among women, accounting for important sleep-related and social factors. Since 2010 we have been studying sleep disorders among women Veterans, initially focusing on insomnia disorder. Through this work we discovered that a significant segment of women served by VA also are high risk for sleep disordered breathing (SDB; also referred to as sleep apnea), particularly if they report poor sleep. In treating insomnia, we found that the initial discomfort created by traditional cognitive-behavioral therapy for insomnia (e.g. initial sleep restriction) is difficult for many women Veterans to tolerate. We developed and are now testing an insomnia intervention based on Acceptance and Commitment Therapy (ACT), called “Acceptance and the Behavioral Changes to Treat Insomnia” or “ABC-I”. Within ACT, treatment focuses on a patient's values and reasons for implementing behavioral changes, and teaches the patient strategies for tolerating temporary discomfort in pursuit of goals consistent with one's values. We now propose to use these same therapeutic approach, adopted from ACT, to address unique challenges faced by women Veterans in adjusting to PAP therapy. This study is a randomized controlled trial (RCT) to test the efficacy of a program combining patient education with ACT-based techniques in improving adherence to PAP therapy, called “ABC-SA” or “Acceptance and the Behavioral Changes to treat Sleep Apnea.” This 6-session intervention will address initial discomfort, link treatment to the patient’s values and incorporate methods for accepting the changes that are required to treat SDB. Main study outcomes will be assessed 3 months after PAP initiation, and PAP adherence will be tracked remotely for 12 months. The 6-session “control” intervention will account for the contact with a study interventionist and will be modeled after usual care. The objectives of this proposal are: (1) to test the efficacy of the ABC-SA program in improving PAP adherence, compared to a control program modeled after usual care, for women Veterans with SDB; (2) to test the efficacy the ABC-SA program for improving objectively-measured and patient-reported sleep quality, compared to the control program; and (3), to test the efficacy the ABC-SA program for improving quality of life and symptoms of depression, compared to the control program. Data will be analyzed using “intention to treat” principles, using appropriate statistical methods for clinical trials.

睡眠失调呼吸（SDB）与重大不良健康后果有关 心血管疾病，汽车事故，日间功能障碍和死亡率风险。虽然 SDB在男性中比女性更为普遍，它仍然影响17％的女性。 [我们的 初步证据表明，在接受VA护理的女退伍军人中，这更为普遍。] 大多数SDB患者的建议一线治疗是气道阳性压力疗法（PAP）。 发表的研究表明，女性的依从性比男性较低，尤其是在美国，但我们是 不知道比较男女退伍军人的数据。因为女退伍军人经历了重要的 睡眠障碍和睡眠障碍的其他后果，适应PAP疗法可能非常困难。 迄今 考虑重要的与睡眠有关的社会因素。 自2010年以来，我们一直在研究女性退伍军人的睡眠障碍，最初关注失眠症 紊乱。通过这项工作，我们发现VA服务的大量妇女也是高风险 对于睡眠失调的呼吸（SDB；也称为睡眠呼吸暂停），尤其是当他们报告睡眠不佳时。在 治疗失眠，我们发现传统认知行为疗法造成的最初不适 失眠（例如初始睡眠限制）对于许多女性退伍军人来说很难容忍。我们开发了，正在 现在根据接受和承诺疗法（ACT）测试失眠干预措施，称为 “接受和治疗失眠的行为变化”或“ ABC-I”。在ACT中，治疗重点是 患者的价值观和实施行为改变的原因，并教授患者策略 在追求与一个人的价值观一致的目标时，可以容忍暂时的不适。我们现在建议使用这些 从行为采用的相同的治疗方法，以应对女性退伍军人面临的独特挑战 适应子宫颈羊疗法。 这项研究是一项随机对照试验（RCT），以测试将患者组合的程序的效率 通过基于ACT的技术进行教育，以改善称为“ ABC-SA”或 “接受和行为变化以治疗睡眠呼吸暂停。”这项六项课程将解决最初的问题 不适，将治疗链接到患者的价值观，并结合了接受更改的方法 需要治疗SDB。主要研究结果将在PAP启动后3个月和PAP进行评估 依从性将远程跟踪12个月。 6条“控制”干预将考虑 与研究干预主义者接触，并在通常的护理后进行建模。 该提案的目标是：（1）测试ABC-SA计划在改善PAP方面的效率 与SDB的女退伍军人相比，与以通常的护理为基础的对照计划相比，依从性； （2）测试 ABC-SA计划改善客观测量和患者报告的睡眠质量的有效性， 与控制程序相比； （3），测试效率ABC-SA计划以提高生活质量 与对照计划相比，抑郁症的症状。将使用“治疗意图”对数据进行分析 原理，使用适当的统计方法进行临床试验。