Improving sleep apnea treatment adherence after traumatic brain injury: A nonrandomized feasibility study.
Improving sleep apnea treatment adherence after traumatic brain injury: A nonrandomized feasibility study.
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DOI：
10.1037/rep0000473
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发表时间：
2022-11
影响因子：
2.7
通讯作者：
Nakase-Richardson R
中科院分区：
文献类型：
--
作者：
Silva MA;Arriola NB;Radwan CK;Womble BM;Healey EA;Lee JM;Aloia MS;Nakase-Richardson R
目的：评估心理干预的可行性，旨在提高对阻塞性睡眠呼吸暂停(OSA)和创伤性脑损伤(TBI)并存的阻塞性睡眠呼吸暂停(OSA)和创伤性脑损伤(TBI)患者的正压(PAP)依从性，并适应认知调节。这是一项开放标签的单臂(非随机)研究。资格标准为中到重度创伤性脑损伤、OSA诊断、处方PAP、未依从性和能够同意。参与者是从三级护理医院的住院和门诊环境中招募的。4个模块的人工干预主要通过远程医疗提供。所衡量的可行性方面包括资格、征聘和保留率；会期和出席率；以及成果和进程措施的特点(例如完成率、数据分布)。症状测量包括Epworth嗜睡量表、疲劳严重程度量表、睡眠功能结果问卷、睡眠呼吸暂停自我效能量表、阻塞性睡眠呼吸暂停综合征治疗障碍问卷(OTBQ)和修订后的Kim Alliance量表。在230人的筛查中，14.3%的人符合条件。招聘率(n=17)为51.5%。保留率(n=13)为76.5%。治疗完成者没有丢失数据。OTBQ偏离了常态，但其他措施有足够的偏度(<；2.0)和峰度(<；7.0)，并且没有显著的地板和天花板效应(<；15%)。改变分数的效应大小从小到中等(d=0.10-0.77)。没有不良事件发生。这些结果提供了应该如何修改程序以提高未来临床试验测试这种依从性干预的有效性的成功的方法。应重新考虑纳入标准，并扩大招聘网站，以涵盖符合条件的人，并充分支持疗效研究。
To evaluate the feasibility of a psychological intervention designed to increase Positive Airway Pressure (PAP) adherence, adapted with cognitive accommodations for comorbid obstructive sleep apnea (OSA) and traumatic brain injury (TBI). This was an open-label single arm (nonrandomized) study. Eligibility criteria were moderate-to-severe TBI, OSA diagnosis, prescribed PAP, nonadherent, and able to consent. Participants were recruited from inpatient and outpatient settings at a tertiary care hospital. The 4-module manualized intervention was delivered primarily via telehealth. Feasibility aspects measured included eligibility, recruitment, and retention rates; session duration and attendance; and characteristics of outcome and process measures (e.g., completion rates, data distribution). Symptom measures included the Epworth Sleepiness Scale, Fatigue Severity Scale, Functional Outcomes of Sleep Questionnaire, Self-Efficacy Measure for Sleep Apnea, OSA Treatment Barriers Questionnaire (OTBQ), and Kim Alliance Scale-Revised. Of 230 persons screened, 14.3% were eligible. Recruitment rate (n=17) was 51.5%. Retention rate (n=13) was 76.5%. Treatment completers had no missing data. The OTBQ deviated from normality, but other measures had adequate skew (< 2.0) and kurtosis (< 7.0) and were free from significant floor and ceiling effects (<15%). Change score effect sizes were minimal to moderate (d = 0.10–0.77). There were no adverse events. These results inform ways in which procedures should be modified to enhance the success of a future clinical trial testing the efficacy of this adherence intervention. Inclusion criteria should be reconsidered, and recruitment sites expanded, to capture eligible persons and adequately power an efficacy study.