Adherence to PAP Treatment: Influences of Co-Morbid Insomnia and of Race/Ethnicity

坚持 PAP 治疗：共病失眠和种族/民族的影响

• 批准号: 8968101
• 负责人: NATASHA J WILLIAMS
• 金额: $ 16.26万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8968101
• 关键词: Address; Adherence; Adverse effects; Behavior Therapy; Behavioral; Blood Pressure; Brain; Cardiovascular Diseases; Cardiovascular system; Clinic; Clinical; Clinical Research; Communities; Comorbid Insomnia; Comorbidity; Consultations; Coupled; Data; Development; Diagnosis; Disease Outcome; Epidemiologic Studies; Ethnic Origin; Ethnic group; Failure; Fostering; Funding; Goals; Gold; Grouping; Health; Health education; High Prevalence; Hour; Individual; Intervention; Interview; K-Series Research Career Programs; Laboratories; Left; Lipids; Lipoproteins; Literature; Mediating; Medical center; Medicine; Mentors; Mentorship; Metabolic; Methods; Minority; Morbidity - disease rate; Myocardial Infarction; Obstructive Sleep Apnea; Outcome Study; Outcomes Research; Patients; Polysomnography; Population; Prevalence; Productivity; Public Health; Race; Recruitment Activity; Relative (related person); Research; Research Personnel; Resources; Risk Factors; Risk Marker; Risk Reduction; Role; Sampling; Scientist; Self Efficacy; Serum; Severities; Sleep; Sleep Disorders; Sleeplessness; Specialist; Stroke; Symptoms; Time; Training; Uncertainty; Uncontrolled Study; United States National Institutes of Health; Work; Workplace; acute coronary syndrome; base; behavior change; cardiovascular disorder risk; cardiovascular risk factor; contextual factors; diagnosis standard; diaries; experience; follow-up; health disparity; improved; indexing; innovation; insight; insulin sensitivity; multidisciplinary; novel; patient oriented; pressure; prevent; primary outcome; programs; public health relevance; racial and ethnic; racial and ethnic disparities; racial/ethnic difference; skills; symposium; tool; treatment effect

 DESCRIPTION (provided by applicant): Background: Increasing evidence from clinical studies suggests an association between obstructive sleep apnea (OSA) and insomnia, with the prevalence of this comorbidity ranging from 39% to 58%. Further, comorbid insomnia has emerged as an important clinical factor that can worsen adherence to Positive Airway Pressure (PAP) treatment, which is the first-line of treatment for patients diagnosed with OSA. Although these findings provide important insight, they are not without limitations. First, the variability n the prevalence of comorbid insomnia and OSA results from methodological limitations in assessing insomnia symptoms, including a failure to use validated tools. Second, existing studies are largely conducted in homogenous samples, making it impossible to assess racial/ethnic disparities, which is a growing concern in understanding poor adherence to PAP treatment. Research: The proposed study within this K-Award, which will be the first step in a larger program of research to identify factors that contribute to poor adherence to PAP treatment, and how these differ between black and white patients. This will ultimately (1) enable clinical profiling of individuals with comorbid insomnia and OSA, (2) determine whether black patients diagnosed with OSA differ from their white counterparts with respect to adherence to PAP treatment, and (3) determine whether [comorbid insomnia] mediates the relationship between [race/ethnicity and poor adherence to PAP treatment] above and beyond patient and contextual factors. The proposed study will leverage the resources of the NYU and Weill Cornell Sleep Disorders Center to recruit [108] patients recently diagnosed with OSA, based on polysomnography, the gold standard for diagnosing OSA. Of these, [54 will present with comorbid insomnia and 54 without comorbid insomnia]. Polysomnography will be coupled with [a clinical interview by trained staff at the sleep clinic to classify insomnia symptoms along with the Insomnia Severity Index, and actigraphically-derived sleep data anchored by a 7-day sleep diary] and objective data for adherence to PAP treatment. The primary outcome for the study is adherence to PAP over 6 months. Training: This component of the K23 is composed of the didactic and mentored experiences required to develop the proposed program of research. The training plan builds upon my background and experience in health education with minority populations, and will provide me with the necessary training in sleep research, [epidemiology], behavioral sleep medicine, conduct of innovative health interventions, and quantitative skills. The pedagogical approach includes one-on-one mentorship, course work, mentored laboratory training, and attendance of targeted conferences and seminars, all with the common goal of supporting my transition to become an independent investigator.

 描述（由申请人提供）： 背景：越来越多的临床研究证据表明阻塞性睡眠呼吸暂停 (OSA) 与失眠之间存在关联，这种合并症的患病率范围为 39% 至 58% 此外，合并失眠已成为一种重要的疾病。可以加深对气道正压通气 (PAP) 治疗依从性的临床因素，这是诊断为 OSA 的患者的一线治疗方法，尽管这些发现提供了重要的信息。首先，失眠和 OSA 合并症的患病率存在​​差异，这是由于评估失眠症状的方法学上的局限性造成的，包括未能使用经过验证的工具；其次，现有的研究主要是在同质样本中进行的。无法评估种族/民族差异，这是了解 PAP 治疗依从性差的一个日益令人担忧的问题 研究：本 K 奖中拟议的研究，这将是确定影响因素的更大研究计划的第一步。依从性差以及黑人和白人患者之间的差异，这最终将 (1) 对患有失眠症和 OSA 的个体进行临床分析，(2) 确定诊断患有 OSA 的黑人患者在依从性方面是否有所不同。 (3) 确定[共病失眠]是否在[种族/族裔与 PAP 治疗依从性差]之间的关系中发挥作用，超越患者和背景因素。拟议的研究将利用纽约大学和环境因素的资源。威尔康奈尔睡眠障碍中心根据多导睡眠图（诊断 OSA 的金标准）招募 [108] 名最近诊断为 OSA 的患者，其中，[54 名患有共病失眠，54 名没有共病失眠]。由睡眠诊所训练有素的工作人员进行临床访谈，对失眠症状进行分类 失眠严重程度指数、以 7 天睡眠日记为基础的活动记录睡眠数据以及坚持 PAP 治疗的客观数据 该研究的主要结果是坚持 6 个月以上的 PAP 训练：K23 的这一部分。由制定拟议研究计划所需的教学和指导经验组成。该培训计划以我在少数民族人口健康教育方面的背景和经验为基础，并将为我提供睡眠研究方面的必要培训， [流行病学]、行为睡眠医学、创新健康干预措施和定量技能教学方法包括一对一指导、课程作业、指导实验室培训以及参加有针对性的会议和研讨会，所有这些的共同目标是支持我转型成为一名独立调查员。