Nuestro Sueno: Cultural Adaptation of a Couples Intervention to Improve PAP Adherence and Sleep Health Among Latino Couples with Implications for Alzheimer’s Disease Risk

Nuestro Sueno：夫妻干预措施的文化适应，以改善拉丁裔夫妇的 PAP 依从性和睡眠健康，对阿尔茨海默病风险产生影响

• 批准号: 10766947
• 负责人: Carmela Alcantara
• 金额: $ 39.29万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10766947
• 关键词: Acculturation; Address; Adherence; Adult; Affect; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Arizona; Beds; Belief; Cardiometabolic Disease; Cognition; Cognition Disorders; Cognitive aging; Collaborations; Communication; Communities; Community Health Aides; Couples; Data; Dedications; Dementia; Development; Diagnostic; Disease; Disparity; Ethnic Population; Evidence based intervention; Family; Focus Groups; Future; Goals; Health; Impaired cognition; Individual; Intervention; Language; Latino; Latino Population; Link; Measures; Medical; Metaphor; Modeling; Morbidity - disease rate; National origin; Not Hispanic or Latino; Obstructive Sleep Apnea; Outcome; Patient Noncompliance; Patients; Phase; Population; Prevention; Process; Public Health; Quality of life; Randomized, Controlled Trials; Research; Risk; Risk Reduction; Role; Sampling; Site; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Sleeplessness; Socioeconomic Status; Solid; Symptoms; System; Testing; Translations; United States; United States National Institutes of Health; Utah; actigraphy; behavioral adherence; behavioral health intervention; cardiometabolic risk; cognitive function; cognitive performance; coping; cultural values; dementia risk; diaries; disparity reduction; evidence base; experience; feasibility testing; field study; flexibility; follow-up; health disparity; healthy aging; high risk; improved; innovation; mortality; neglect; novel; positive airway pressure; prevent; racial disparity; racial population; randomized, clinical trials; response; satisfaction; sleep health; social culture; sociocultural determinant; socioeconomic disparity; telehealth; therapy development; treatment adherence; treatment arm; treatment disparity; treatment response; Acculturation; Address; Adherence; Adult; Affect; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Arizona; Beds; Belief; Cardiometabolic Disease; Cognition; Cognition Disorders; Cognitive aging; Collaborations; Communication; Communities; Community Health Aides; Couples; Data; Dedications; Dementia; Development; Diagnostic; Disease; Disparity; Ethnic Population; Evidence based intervention; Family; Focus Groups; Future; Goals; Health; Impaired cognition; Individual; Intervention; Language; Latino; Latino Population; Link; Measures; Medical; Metaphor; Modeling; Morbidity - disease rate; National origin; Not Hispanic or Latino; Obstructive Sleep Apnea; Outcome; Patient Noncompliance; Patients; Phase; Population; Prevention; Process; Public Health; Quality of life; Randomized, Controlled Trials; Research; Risk; Risk Reduction; Role; Sampling; Site; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Fragmentations; Sleep disturbances; Sleeplessness; Socioeconomic Status; Solid; Symptoms; System; Testing; Translations; United States; United States National Institutes of Health; Utah; actigraphy; behavioral adherence; behavioral health intervention; cardiometabolic risk; cognitive function; cognitive performance; coping; cultural values; dementia risk; diaries; disparity reduction; evidence base; experience; feasibility testing; field study; flexibility; follow-up; health disparity; healthy aging; high risk; improved; innovation; mortality; neglect; novel; positive airway pressure; prevent; racial disparity; racial population; randomized, clinical trials; response; satisfaction; sleep health; social culture; sociocultural determinant; socioeconomic disparity; telehealth; therapy development; treatment adherence; treatment arm; treatment disparity; treatment response

Abstract Latino adults in the United States (U.S.) are 1.5 times more likely to develop Alzheimer’s disease (AD) and related dementias (ADRD) compared to non-Hispanic white adults. Obstructive sleep apnea (OSA) affects 9.8% of Latino adults and confers a five-fold increased risk of AD diagnosis5. Consequences also extend to the bedpartner, as bedpartners of those with OSA experience significant sleep disturbances, including sleep fragmentation and 3 times greater risk of insomnia. Given solid mechanistic links between both OSA and insomnia and ADRD risk, effective OSA treatment has the potential to promote healthy cognitive aging and reduce ADRD risk for both partners. While the front-line treatment for OSA, positive airway pressure (PAP), is highly effective at reducing OSA symptoms and may reduce or forestall ADRD risk, its potential is severely diminished, as up to 80% of patients are non-adherent. Extant PAP adherence interventions are limited in that they are exclusively focused on the individual, neglecting to consider the role of the bedpartner in treatment, and developed primarily in non-Hispanic white populations. Therefore, there is a critical need to develop evidence-based, and culturally-adapted interventions that address the impact of OSA and its treatment on both partners and within a culturally-tailored framework. The goal of this R61/33 proposal is to develop and test “Nuestro Sueño” a culturally-adapted intervention to promote PAP adherence and sleep health among Latino couples. This proposal builds on and extends our team’s recently completed R21 project called “WePAP”, a brief (3 session) telehealth intervention to promote PAP adherence and sleep health among couples with OSA. Pilot data demonstrates our intervention is feasible, acceptable and shows promise for improving adherence, sleep, relationship quality and cognitive function for patient and partners. Therefore, in the next steps, we propose to 1) Conduct a rigorous cultural adaptation and testing process of Nuestro Sueño, utilizing input from a community advisory board, patient/partner focus groups and field testing and 2) Conduct a randomized clinical trial to evaluate the feasibility, treatment satisfaction and preliminary efficacy of Nuestro Sueño versus information control (IC) in a sample of 80 OSA patients and their partners (i.e., 40 couples per treatment arm) across two sites (Utah and Arizona). The intervention focuses specifically on the interpersonal mechanisms of enhancing dyadic coping and communication, using intervention materials resonant with cultural beliefs and values. If successful, Nuestro Sueño, an innovative and culturally-adapted intervention, has the potential to significantly advance the treatment of OSA, and may elucidate a critical, modifiable target of prevention and intervention to promote healthy aging and reduce disparities in ADRD risk among Latino couples.

抽象的 美国（美国）的拉丁裔成年人患阿尔茨海默氏病（AD）和 与非西班牙裔白人成年人相比，相关痴呆症（ADRD）。阻塞性睡眠呼吸暂停（OSA）影响 9.8％的拉丁裔成年人承认AD诊断的风险增加了五倍。后果也扩展到 BedPartner，作为OSA患者的床单，患有严重的睡眠障碍，包括睡眠 碎裂和失眠风险的3倍。给定OSA和OSA和 失眠和ADRD风险，有效的OSA治疗有可能促进健康的认知衰老和 减少双方的ADRD风险。虽然OSA的前线治疗（PAP）是 高效减少OSA符号并可能降低或阻止ADRD风险，其潜力严重 减少，因为多达80％的患者是非依从性的。现存的PAP依从性干预受到限制 他们仅专注于个人，忽略了床单在治疗中的作用， 并主要在非西班牙裔白人种群中发展。因此，迫切需要发展 基于证据的和具有文化适应的干预措施，以解决OSA及其治疗对两者的影响 合作伙伴和在文化定制的框架内。该R61/33建议的目标是开发和 测试“ NuestroSueño”一种培养的改编干预措施，以促进PAP依从性和睡眠 拉丁裔夫妇的健康。该提案建立并扩展了我们团队最近完成的R21 名为“ WEPAP”的项目，这是一项简短的（3个会话）远程医疗干预措施，以促进PAP依从性和睡眠健康 在与OSA的夫妇中。飞行员数据表明​​我们的干预是可行的，可接受的，并显示出希望 为了改善患者和伴侣的依从性，睡眠，关系质量和认知功能。所以， 在接下来的步骤中，我们提议1）进行严格的文化适应和测试过程 Sueño，使用社区顾问委员会，患者/合作伙伴焦点小组和现场测试的意见以及2） 进行随机临床试验，以评估可行性，治疗满意度和初步有效性 NuestroSueño与信息控制（IC）的80例OSA患者及其伴侣样本（即40个） 每个治疗臂的夫妻）遍布两个地点（犹他州和亚利桑那州）。干预专门针对 使用干预材料增强二元应对和交流的人际交往机制 与文化信念和价值观共鸣。如果成功，NuestroSueño是一种创新和文化适应的 干预，有可能显着提高OSA的治疗，并可能阐明一个关键， 可修改预防和干预的目标，以促进健康的衰老并减少ADRD风险的分布 在拉丁裔夫妇中。