Examining Early Intervention Obstructive Sleep Apnea Treatment on Long-Term Outcomes in Veterans with SUD/PTSD in a Residential Treatment Program

在住院治疗计划中检查早期干预阻塞性睡眠呼吸暂停治疗对患有 SUD/PTSD 的退伍军人的长期结果

• 批准号: 10640107
• 负责人: Peter Colvonen
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640107
• 关键词: Adherence; Affect; Aftercare; Alcohol consumption; Arousal; Back; Blood; Breathing; Caring; Clinical; Control Groups; Diagnosis; Disease; Early Intervention; Effectiveness; Emotional; Exhibits; Feeling suicidal; Female; Goals; Health; Health Care Costs; Heart failure; Hour; Hypertension; Impairment; Individual; Knowledge; Link; Mental Depression; Mental Health; Methodology; Obesity; Obstructive Sleep Apnea; Outcome; Outpatients; Participant; Patients; Peripheral; Physical Function; Post-Traumatic Stress Disorders; Protocols documentation; Quality of life; Recovery; Relapse; Research; Residential Treatment; Severities; Sleep Fragmentations; Sleep disturbances; Substance Use Disorder; Suicide; Suicide attempt; Symptoms; Time; Treatment Efficacy; Treatment outcome; Veterans; Wait Time; Waiting Lists; World Health Organization Disability Assessment Schedule; adherence rate; clinical practice; comorbidity; coping; desensitization; distraction; drinking; evidence base; follow up assessment; follow-up; functional disability; functional improvement; functional outcomes; group intervention; improved; male; methamphetamine use; military veteran; opioid use; positive airway pressure; psychologic; randomized, controlled study; reduced substance use; response; screening; social; standard care; stressor; substance use; substance use treatment; suicidal behavior; sustained recovery; timeline; treatment adherence; treatment group; treatment program

Objectives. Substance use disorder (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur and having one condition worsens the course of the other. Individuals with both disorders exhibit worse functioning across a number of domains than individuals with either disorder alone. This is especially true in residential settings where both disorders are more severe than outpatient settings. Compared to Veterans with a single disorder, Veterans with SUD/PTSD also are more likely to have suicidal ideation and to have attempted suicide. Examining treatable conditions that are associated with improved SUD and PTSD outcomes, such as obstructive sleep apnea (OSA), can maximize treatment efficacy for Veterans at a critical time in recovery. OSA is highly comorbid with both PTSD and SUD with upwards of 67 to 83% of Veterans with SUD or PTSD also having OSA. Further, untreated OSA is associated with worse functional impairment across multiple domains, worse quality of life, worse PTSD, and higher substance use and relapse rates. Importantly, untreated OSA also contributes to higher suicide attempts and completion. Positive airway pressure (PAP) is the gold standard treatment for OSA with large effects on multiple domains of functioning, quality of life, PTSD symptoms, physical functioning, lower depression, and better emotional coping. Unfortunately, screening and treating Veterans for OSA is not a part of clinical practice for SUD or PTSD treatment; as such the average wait time for individuals to get PAP therapy is upward of two years. Despite the widespread dissemination of knowledge regarding the detrimental effects of untreated OSA and the incredible effectiveness of PAP treatment, OSA is rarely screened for or treated in patients with SUD or PTSD, with approximately 80% to 90% of Veterans with OSA remaining undiagnosed and untreated. Methodology. We aim to examine the effects of PAP treatment on Veterans with PTSD and SUD on a 28- day residential unit. We are proposing a randomized controlled study comparing two groups: an early intervention PAP treatment group receiving PAP treatment while on the residential unit, compared to a waitlist control group who will receive PAP treatment at 3-months post-discharge follow-up. Participants will be 194 male and female Veterans on the residential SUD and PTSD unit with SUD, PTSD, and OSA. Our primary aim is to determine the relative efficacy of PAP treatment on the SUD/PTSD unit, as compared to waitlist control, in reducing problematic substance use, PTSD symptoms, and suicidal ideation, while improving functioning among Veterans with comorbid SUD/PTSD at 3-months post-treatment follow-up. We will also compare PAP adherence rates on PTSD/SUD/functioning outcomes within the PAP treatment group (3-months). Finally, we plan on comparing adherence rates between the two treatment groups at the 6-months post-treatment follow- up assessment. Examining OSA treatment for SUD and PTSD is highly relevant to the goals of RR&D and the VA to maximize treatment efficacy for Veterans and has the potential to improve functional and psychological recovery for a highly prevalent and highly impaired population of Veterans. This research will directly impact functional outcomes, SUD recovery, and PTSD symptoms in already vulnerable Veterans struggling with SUD and PTSD. The successful completion of this project will help improve the practices that drive treatment for Veterans who have both SUD and PTSD. The fundamental rationale for this study is to improve the evidence base that informs how patients with SUD and PTSD can attain sustained recovery from both of these disorders. Colvonen - 1

目标。药物使用障碍 (SUD) 和创伤后应激障碍 (PTSD) 经常同时发生 一种情况会使另一种情况恶化。患有这两种疾病的个体表现更差 与单独患有任何一种疾病的人相比，他们在多个领域都有功能。尤其是在 这两种疾病比门诊环境更严重的住宅环境。与退伍军人相比 作为一种单一疾病，患有 SUD/PTSD 的退伍军人也更有可能有自杀意念并有 企图自杀。检查与改善 SUD 和 PTSD 相关的可治疗病症 阻塞性睡眠呼吸暂停 (OSA) 等结果可以在关键时刻最大限度地提高退伍军人的治疗效果 恢复时间。 OSA 与 PTSD 和 SUD 高度共存，超过 67% 至 83% 的退伍军人患有 SUD 或 PTSD 也有 OSA。此外，未经治疗的 OSA 与更严重的功能障碍有关 多个领域、更差的生活质量、更严重的创伤后应激障碍以及更高的物质使用和复发率。重要的是， 未经治疗的阻塞性睡眠呼吸暂停也会导致更高的自杀企图和完成率。气道正压通气 (PAP) 是 OSA 的黄金标准治疗方法，对功能、生活质量、创伤后应激障碍 (PTSD) 等多个领域具有重大影响 症状、身体机能、较低的抑郁程度和更好的情绪应对能力。不幸的是，筛选和 治疗退伍军人的 OSA 不属于 SUD 或 PTSD 治疗临床实践的一部分；因此平均 个人接受 PAP 治疗的等待时间长达两年以上。尽管广泛传播 关于未经治疗的 OSA 的有害影响以及 PAP 令人难以置信的有效性的知识 在 SUD 或 PTSD 患者中很少进行 OSA 筛查或治疗，大约 80% 至 90% 患有 OSA 的退伍军人仍未得到诊断和治疗。 方法论。我们的目标是检查 PAP 治疗对患有 PTSD 和 SUD 的退伍军人的影响 28- 日间住宅单位。我们正在提议一项随机对照研究，比较两组：早期 干预 PAP 治疗组在住宅单元接受 PAP 治疗，与候补名单相比 对照组将在出院后 3 个月随访时接受 PAP 治疗。参加人数为194人 SUD 和 PTSD 住宅单位的男性和女性退伍军人，患有 SUD、PTSD 和 OSA。我们的首要目标 目的是确定与候补名单对照相比，PAP 治疗对 SUD/PTSD 单位的相对疗效， 减少有问题的物质使用、创伤后应激障碍症状和自杀意念，同时改善功能 在治疗后 3 个月的随访中，患有 SUD/PTSD 共病的退伍军人中。我们还将比较 PAP PAP 治疗组（3 个月）内 PTSD/SUD/功能结果的依从率。最后，我们 计划在治疗后 6 个月随访时比较两个治疗组之间的依从率 上评估。 检查 OSA 对 SUD 和 PTSD 的治疗与 RR&D 和 VA 的目标高度相关 最大限度地提高退伍军人的治疗效果，并有可能改善功能和心理 为高度普遍且高度受损的退伍军人群体提供康复服务。这项研究将直接影响 与 SUD 作斗争的已经脆弱的退伍军人的功能结果、SUD 恢复和 PTSD 症状 和创伤后应激障碍。该项目的成功完成将有助于改善推动治疗的实践 同时患有 SUD 和 PTSD 的退伍军人。本研究的根本目的是为了完善证据 告知 SUD 和 PTSD 患者如何从这两种疾病中获得持续康复的基础 失调。 科尔沃宁 - 1