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: 10411312
• 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/10411312
• 关键词: Adherence; Affect; Aftercare; Alcohol consumption; Arousal; Back; Behavior; Blood; Breathing; Caring; Clinical; Control Groups; Diagnosis; Disease; Early Intervention; Effectiveness; Emotional; Exhibits; Feeling suicidal; Female; Goals; Gold; 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; Sleep disturbances; Substance Use Disorder; Suicide; Suicide attempt; Symptoms; Thinking; Time; TimeLine; 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 outcomes; group intervention; health care service utilization; improved; improved functioning; 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; 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.物质使用障碍（SUD）和创伤后应激障碍（PTSD）经常同时发生 一种情况会影响另一种情况的发展患有这两种疾病的人表现出更差的 在许多领域的功能比单独患有任何一种疾病的人。更是如此 在住院环境中，这两种疾病都比门诊环境更严重。与退伍军人相比， 单一的疾病，有SUD/PTSD的退伍军人也更有可能有自杀意念， 企图自杀检查与改善SUD和PTSD相关的可治疗疾病 结果，如阻塞性睡眠呼吸暂停（OSA），可以最大限度地提高退伍军人的治疗效果， 时间恢复。 OSA与PTSD和SUD高度共病，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相关， 多个领域，更差的生活质量，更严重的PTSD，更高的物质使用和复发率。重要的是， 未经治疗的OSA也有助于更高的自杀企图和完成。气道正压通气（PAP） OSA的金标准治疗对多个功能领域、生活质量、PTSD有很大影响， 症状，身体功能，更低的抑郁症，更好的情绪应对。不幸的是，筛选和 治疗OSA的退伍军人不是SUD或PTSD治疗临床实践的一部分;因此， 个人接受PAP治疗的等待时间超过两年。尽管广泛传播， 关于未经治疗的OSA的有害影响和PAP令人难以置信的有效性的知识 在治疗中，OSA很少在SUD或PTSD患者中进行筛查或治疗，大约80%至90%的患者患有OSA。 患有阻塞性睡眠呼吸暂停综合症的退伍军人中有10%未被诊断和治疗。 方法论我们的目的是研究PAP治疗对患有PTSD和SUD的退伍军人的影响， 日间住宿单位。我们建议进行一项随机对照研究，比较两组： 干预PAP治疗组接受PAP治疗，而在住宅单位，相比，等待名单 对照组，出院后3个月随访时接受PAP治疗。参加者194人 男性和女性退伍军人在住宅SUD和创伤后应激障碍单位与SUD，创伤后应激障碍，和OSA。我们的主要目的 是为了确定PAP治疗对SUD/PTSD单位的相对疗效，与等待名单对照相比， 减少有问题的物质使用，PTSD症状和自杀意念，同时改善功能 在治疗后3个月随访时患有SUD/PTSD共病的退伍军人中。我们还将比较PAP PAP治疗组内PTSD/SUD/功能结局的依从率（3个月）。最后我们 计划在治疗后6个月比较两个治疗组之间的依从率- 向上评估。 检查SUD和PTSD的OSA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 为退伍军人的高度流行和高度受损的人口恢复。这项研究将直接影响 功能结果、SUD恢复和创伤后应激障碍症状在已经脆弱的与SUD作斗争的退伍军人中 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做法， 有SUD和PTSD的退伍军人。这项研究的基本原理是改善证据 一个基础，告知SUD和PTSD患者如何从这两种疾病中获得持续康复 紊乱 科尔沃宁-1