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.

项目概要有证据表明，阻塞性睡眠呼吸暂停 (OSA) 患者的 tau 蛋白和淀粉样蛋白 - β 负担增加。记忆力、执行功能、注意力和警觉性受损在这些患者中也很常见。幸运的是，OSA 治疗可以使这些阿尔茨海默病 (AD) 的生物标志物正常化并改善治疗还可以减少全身炎症并改善胰岛素敏感性、血液。尽管有这些令人信服的数据，但人们对这些因素知之甚少。 OSA 治疗对黑人的影响，这个群体承担着 OSA 和 AD 的不成比例的负担。未能从这些医学进步中受益的部分原因是缺乏数据来解释难以获得的信息充分的 OSA 护理，限制了我们实施指导积极的 OSA 控制的卫生政策的能力我们提出一项随机对照试验来评估我们创新的个性化 OSA 治疗的有效性。提高黑人对 OSA 治疗依从性的依从模型我们将实施有效的方法。和可扩展的干预措施，以确定 OSA 治疗对 AD 生物标志物和认知功能的影响首先，我们将利用利益相关者认可的基于网络的睡眠。我们开发了教育平台（TASHE），以患有 OSA 的黑人患者的旅程为特色。使用个性化方法传递视频消息（OSA 内容和辅导建议）以提高 OSA 治疗自我效能信息将根据患者的具体情况进行个性化以推动。并在他们首选的 OSA 护理路径中导航他们。档案将整合患者的基线数据（例如，人口统计、医疗、健康素养、动机、改变的准备程度）以及收集到的新兴障碍从对生态瞬时评估的反应中获取有关克服策略的指导信息。系统级障碍，阻碍 OSA 护理路径的成功导航将使用新诊断的黑人（n = 330，60-85 岁）将被随机暴露于我们将捕获个性化或标准 OSA 消息（例如 AASM 和 NSF）。通过遥测，可以实时应用数据驱动的决策规则来优化消息传递。将确定基线和入组后 6 个月的生物标志物和认知结果。团队将： 1) 评估个性化、基于网络的干预措施在增加新诊断的黑人坚持使用气道正压通气治疗的 OSA 2) 确定； OSA 治疗是否改善 a) AD 分子生物标志物（Hcy、NFL、GFAP、Tau 和 Aβ）和 b) 认知功能（注意力、语言、记忆和执行功能）；以及 3) 确定是否存在 OSA 我们期望治疗能够改善患者的健康相关生活质量、日间功能和睡眠质量。个性化 OSA 治疗依从模型 (PRAISE) 将对 OSA 产生重大影响治疗依从性，从而改善 OSA 相关的临床和以患者为中心的结果。