Personalized OSA treatment and effects on AD biomarkers and cognition among blacks

个性化 OSA 治疗及其对黑人 AD 生物标志物和认知的影响

基本信息

批准号：
10687265
负责人：
Girardin Jean-Louis
金额：
$ 76.34万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10687265
关键词：
Address Adherence Alzheimer&apos s Disease Alzheimer’s disease biomarker Amyloid beta-Protein Attention Behavioral Model Biological Markers Black Populations Blood Pressure Caring Clinic Cognition Cognitive Collaborations Data Disparity Ecological momentary assessment Education Effectiveness Effectiveness of Interventions Enrollment Evaluation Exposure to Failure Focus Groups Fostering Glean Glial Fibrillary Acidic Protein Glucose Glycosylated hemoglobin A Goals Health Health Educators Health Policy Health education Home Impairment Inflammatory Infrastructure Interleukin-10 Interleukin-6 Intervention Joints Language Lipids Lipoproteins Measures Mediating Medical Memory Modality Modeling Molecular Motivation Newly Diagnosed Obesity Obstructive Sleep Apnea Online Systems Outcome Pathway interactions Patient-Focused Outcomes Patients Physicians Public Health Readiness Recommendation Risk Schedule Self Efficacy Serum Shoulder Sleep Sleep Apnea Syndromes Strategic Planning TNF gene Techniques Telemetry Time United States National Institutes of Health black patient brain health clinical center cognitive function comparative effectiveness effectiveness evaluation executive function health data health literacy health related quality of life human centered design human very old age (85+)improved innovation insulin sensitivity literacy minority communities molecular marker novel personalized approach positive airway pressure post intervention prevent response sleep health sleep quality success system-level barriers systemic inflammatory response tau Proteins treatment adherence treatment effect vascular contributions video delivery vigilance web platform web site web-based intervention β-amyloid burden

项目摘要

Project Summary Evidence shows increased tau and amyloid-β burden among patients with obstructive sleep apnea (OSA). Impairment in memory, executive function, attention, and vigilance is also common among those patients. Fortunately, OSA treatment can normalize these biomarkers of Alzheimer’s disease (AD) and improve cognitive function. Treatment can also reduce systemic inflammation and improve insulin sensitivity, blood pressure, and serum lipids and lipoproteins. Notwithstanding such compelling data, little is known about the impact of OSA treatment among blacks, a group shouldering a disproportionate burden of OSA and AD. Failure to benefit from these medical advances is due in part to a dearth of data explaining poor access to adequate OSA care, limiting our ability to implement health policies guiding aggressive OSA control among blacks. We propose an RCT to assess the effectiveness of our innovative Personalized OSA Treatment Adherence Model in enhancing adherence to OSA treatment among blacks. We will implement an effective and scalable intervention to ascertain effects of OSA treatment on AD biomarkers and cognitive function as well as patient-centered outcomes. First, we will leverage a stakeholder-endorsed, web-based sleep education platform (TASHE) we developed, featuring journeys of black patients with OSA. Second, we will use a personalized approach for delivering video messages (OSA content & coaching advice) to increase OSA treatment self-efficacy. Messages will be personalized based on patients’ idiographic profile to nudge and navigate them in their preferred OSA care pathway. Profiles will integrate patients’ baseline data (e.g., demographic, medical, health literacy, motivation, readiness to change) and the emergent barriers gleaned from responses to ecological momentary assessment. Coaching messages about strategies to overcome system-level barriers, impeding successful navigation of the OSA care pathway will be delivered using Motivational Enhancement. Newly diagnosed blacks (n=330, 60-85 years) will be randomly exposed to either the personalized or standard OSA messages (e.g., AASM & NSF). We will capture adherence data via telemetry, enabling real-time application of data-driven decision rules to optimize message delivery. We will ascertain biomarker and cognitive outcomes at baseline and at 6 months post-enrollment. The study team will: 1) assess the comparative effectiveness of the personalized, web-based intervention in increasing adherence to OSA treatment with Positive Airway Pressure among newly diagnosed blacks; 2) determine whether OSA treatment improves a) molecular AD biomarkers (Hcy, NFL, GFAP, Tau and Aβ) and b) cognitive function (attention, language, memory, and executive function); and 3) determine whether OSA treatment improves patients’ health-related quality of life, daytime functioning, and sleep quality. We expect the Personalized OSA Treatment Adherence Model (PRAISE) will have a significant impact on OSA treatment adherence, leading to improved OSA-related clinical and patient-centered outcomes.

项目摘要有证据表明，阻塞性睡眠呼吸暂停（OSA）患者的TAU和淀粉样蛋白β燃烧增加。在这些患者中，记忆力，执行功能，注意力和警惕性的损害也很常见。幸运的是，OSA治疗可以使这些阿尔茨海默氏病（AD）的生物标志物正常化并改善认知功能。治疗还可以降低全身感染并提高胰岛素敏感性，血液压力，血清脂质和脂蛋白。尽管有这种引人入胜的数据，但对 OSA治疗在黑人中的影响，一个小组肩负着OSA和AD的不成比例的Burnen。未能从这些医疗进步中受益的部分是由于数据死亡，解释了不良访问足够的OSA护理，限制了我们实施健康政策指导OSA控制的能力黑人。我们建议RCT评估我们创新的个性化OSA治疗的有效性依从性模型增强了黑人对OSA治疗的依从性。我们将实施有效的以及可扩展的干预措施，以确定OSA治疗对AD生物标志物的影响和认知功能以及以患者为中心的结果。首先，我们将利用基于网络的利益相关者的睡眠我们开发的教育平台（Tashe），包括OSA黑人患者的旅程。第二，我们会的使用个性化方法传递视频消息（OSA内容和教练建议）来增加 OSA治疗自我效能。邮件将根据患者的印度概况进行个性化，以推动并在他们首选的OSA护理途径中导航。概况将整合患者的基线数据（例如，人口统计，医学，健康素养，动机，愿意改变）和紧急障碍收集从对生态瞬时评估的反应。有关克服策略的教练信息系统级障碍，阻碍了OSA护理途径的成功导航励志增强。新诊断的黑人（n = 330，60 - 85年）将随机暴露于个性化或标准OSA消息（例如AASM和NSF）。我们将捕获依从性数据通过遥测，可以实时应用数据驱动的决策规则以优化消息传递。我们将确定基线和注册后6个月的生物标志物和认知结果。研究团队将：1）评估个性化的，基于网络的干预措施的比较有效性在新诊断的黑人中，遵守OSA治疗的阳性压力； 2）确定 OSA处理是否改善A）分子AD生物标志物（HCY，NFL，GFAP，TAU和Aβ）和B）认知功能（注意，语言，记忆和执行功能）； 3）确定OSA是否治疗可改善患者与健康相关的生活质量，日间功能和睡眠质量。我们期望个性化的OSA治疗依从性模型（赞美）将对OSA产生重大影响治疗依从性，从而改善了与OSA相关的临床和以患者为中心的结果。