Self-Management of Continuous Positive Airway Pressure Settings for Veterans with Sleep Apnea

背景：由于临床需求，患者往往没有得到足够的教育和支持。 他们的气道正压(PAP)装置的特点。最敬业的患者是那些理解 他们的设备的详细信息，并改变功能设置，以便他们可以最大限度地发挥治疗的好处。 功能设置包括湿化程度、呼气压力释放、压力上升、口罩警报、自动 压力启动，以及其他重要的舒适性功能。从历史上看，患者没有得到 可以更改或修改治疗压力设置，这需要医生处方。盟军医务人员 可以进行后续的压力设置更改。显然，医疗保健系统很难 从事最佳的慢性病管理，并在早期满足睡眠呼吸暂停患者的需求 治疗初始过程，需要多次就诊/接触，以确保患者 最大限度地利用治疗手段。 目标和目的：拟议项目的总体目标是检查提供 患者有能力调整他们的PAP压力水平对治疗依从性和结果的影响。回答 这些研究问题，建议的睡眠呼吸暂停自我对照随机对照两组试验 管理计划(SM)和SM加个性化压力调整(IPA)具有以下具体内容 与APAP依从性和有效性、患者报告的结果和利用相关的目标：(1)检查 个性化调压(IPA)对治疗依从性和疗效(即面罩)的影响 漏气和残存呼吸暂停低通气指数)；(2)比较丹参与丹参对患者自身的影响。 报告治疗结果；以及(3)描述SM-IPA和SM组对利用率的影响。 意义：睡眠呼吸暂停是退伍军人中最常见的慢性疾病之一。气道正压 睡眠呼吸暂停(PAP)疗法是治疗睡眠呼吸暂停的黄金标准疗法，但坚持使用PAP疗法并不理想。VA睡眠 与临床对教育和支持的需求相比，这些计划人手不足。同时适应PAP 传统上，治疗是通过由提供者发起的顺序访问和压力改变来实现的 在办公室护理中，自我监控和个性化压力调整是一项重要的策略， 将使退伍军人能够更好地控制他们的OSA。这个项目的主要影响是显著的 对于患者(改善的结果)和VA(改善的工作人员效率)。 创新：虽然患者可以控制他们的PAP设备上的一系列舒适功能， 从历史上看，他们没有得到过调整压力设置的正式教育和支持。独一无二的 这项研究的一个方面是关注个性化的压力设置，以实现最大限度的治疗 好处，包括提高PAP遵从性。重要的是，这是在提供商监督的背景下完成的。 方法：本研究是一项为期6个月的随机、对照、非盲法、单中心研究。 睡眠呼吸暂停自我管理程序(SM)与SM加个性化压力调节的比较 (IPA)。两组都将接受SM协议，以确保他们接受相同的OSA和PAP教育 和支持。将向干预部门的参与者提供额外的教育和支持，以 允许他们调整他们的PAP压力。 预期结果：这项研究的积极发现将产生一个工具包，可以通过 VA睡眠网络和美国睡眠呼吸暂停协会为患者和提供者提供 提高阻塞性睡眠呼吸暂停综合征临床管理水平所需的知识。

Background: Because of clinical demands, patients are often under-educated and under-supported about the features of their positive airway pressure (PAP) devices. The most engaged patients are ones who understand the details of their device and change the feature settings so that they can maximize the benefits of therapy. Features settings include humidification level, expiratory pressure relief, pressure ramping, mask alert, auto pressure start, among other important comfort features. Historically, patients have not been provided with access to alter or modify therapy pressure settings, which requires physician prescription. Allied medical staff can carry out subsequent pressure setting changes. It is clear that it is difficult for the healthcare system to engage in optimal chronic disease management, and accommodate the needs of sleep apnea patients early in the treatment initialization process, which requires multiple visits/contacts to ensure that patients are maximizing the use of therapy. Objectives and Aims: The overarching aim of the proposed project is to examine the effect of providing patients with the ability to adjust their PAP pressure levels on therapy adherence and outcomes. To answer these research questions, the proposed randomized, controlled two-group trial of Sleep Apnea Self- Management Program (SM) and SM plus Individualized Pressure Adjustment (IPA) has the following specific aims related to APAP adherence and efficacy, patient-reported outcomes, and utilization: (1) To examine the effect of Individualized Pressure Adjustment (IPA) of settings on treatment adherence and efficacy (i.e., mask leak and residual apnea-hypopnea index); (2) To examine the effect of SM+IPA versus SM on patient self- reported treatment outcomes; and (3) To describe the effects of SM-IPA and SM groups on utilization. Significance: Sleep apnea is one of the most common chronic conditions in the VA. Positive airway pressure (PAP) therapy is the gold-standard therapy for sleep apnea, but adherence with PAP is suboptimal. VA sleep programs are understaffed relative to clinical demand for education and support. While adaption to PAP therapy has traditionally been achieved through sequential visits and pressure changes initiated by providers during office-based care, self-monitoring and individualized pressure adjustment is an important strategy that would empower Veterans to achieve better control of their OSA. The key impacts of this project are significant for both patients (improved outcomes) and the VA (improved staff efficiencies). Innovation: While patients have control over a wide range of comfort features on their PAP devices, historically they have not been formally educated and supported to adjust pressure settings. The unique aspect of this study is the focus on individualizing pressure settings to allow for the maximizing therapeutic benefit, including increased PAP adherence. Importantly, this is done within the context of provider oversight. Methods: The proposed study is a 6-month randomized, controlled, non-blinded, single-center study comparing the Sleep Apnea Self-Management Program (SM) to SM plus Individualized Pressure Adjustment (IPA). Both groups will receive the SM protocol to ensure that they receive identical OSA and PAP education and support. Participants in the intervention arm will be provided with additional education and support that will allow them to adjust their PAP pressures. Expected Results: Positive findings from this study will result in a Toolkit that can be distributed through the VA Sleep Network and the American Sleep Apnea Association to provide patients and providers with the knowledge necessary to improve the clinical management of OSA.