RURAL DWELLING OLDER ADULTS: CPAP ADHERENCE SUPPORT

阻塞性睡眠呼吸暂停(OSA)是基本上健康的老年人中最普遍和代价最高的睡眠障碍。阻塞性睡眠呼吸暂停综合症与心血管和神经认知后遗症以及因交通事故和其他事故造成的公共安全损失有关，这些事故每年造成430亿至560亿美元的损失(全国委员会睡眠报告，第1号，1993)。阻塞性睡眠呼吸暂停采用夜间持续正压(CPAP)呼吸控制，这是治疗的首选方法(国家睡眠委员会报告第2号，1994)。这项随机临床试验的主要目的是确定对168名患有阻塞性睡眠呼吸暂停综合征的农村老年人进行CPAP呼吸机综合干预的长期依从性、健康状况、生活质量和成本效益。依从性由微处理器压力传感器计时器/记录器测量，作为患者每晚使用CPAP的小时数。第二个目标是评估CPAP遵守、生活质量、家庭照顾、使用驾驶安全决策辅助工具和事故之间的关系。干预是从Triandis和Smith模型衍生出来的，每个干预步骤都在老年人中进行了测试。干预步骤逐渐增加强度，从自我定向和专注的咨询到家庭双向远程健康监测，允许护士指导CPAP护理，并评估坚持和互联网互动的身体和情感障碍。在这项拟议的研究中，干预步骤仅在患者没有遵守规定的CPAP治疗时才按标准实施。这些步骤使用音乐和聚焦的图像来启动CPAP的习惯，并使其敏感于CPAP的生理和情感益处，并动员家庭克服使用CPAP的障碍。通过互联网，受试者与同行和专业顾问建立联系，参与互动的遵守支持活动，在寻求未经证实的治疗方法时获得准确的信息，并使用决策辅助工具进行驾驶。一所已建立的大学。Ks.多学科小组将与大学签订分包合同，进行这项研究。威斯康星。这项拟议研究的长期目标是验证CPAP遵守支持系统，该系统将最终提高患者和家属照顾者的生活质量和公共安全，并降低患者和家属照顾者的发病率和每年因不遵守CPAP而花费的1000亿美元。

Obstructive Sleep Apnea (OSA) is the most prevalent and costly sleep disorder in essentially healthy older adults. OSA is assoicated with cardiovascular and neurocognitive sequaela and with public safety losses due to traffic fatalities and other accidents that cost 43 to 56 billion dollars annually (National Commission Sleep Report, number 1, 1993). OSA is controlled with nightly Continuous Positive Airway Pressure (CPAP) ventilation, the treatment of choice (National Commission on Sleep Report number 2, 1994). The primary aim of this randomized clinical trial is to determine the long-term adherence, health, quality of life outcomes, and cost-benefit of a comprehensive intervention on CPAP ventilation in 168 rural dwelling older adults with OSA. Adherence is measured by microprocessor pressure-sensor timer/recorder as patient hours of nightly CPAP use. The Secondary Aim is to assess relationships among CPAP adherence, quality of life, family caregiving, use of a decision aid for driving safety and accidents. The intervention was derived from Triandis and Smith models and each intervention step has been tested in older adults. The intervention steps gradually increase in intensity from self-directed and focused counseling to in home 2-way telehealth monitoring that allows a nurse to direct CPAP care and assess for physical and emotional barriers to adherence and internet interaction. Intervention steps in this proposed study are administered per criteria only if the patient is not adhering to the prescribed CPAP treatment. The steps use music and focused imagery for CPAP habit initiation and sensitization to physiologic and affective benefits from CPAP and mobilizing the family to overcome barriers to CPAP use. Through the internet, subjects connect to peer and professional counselors, engage in interactive adherence support activities, obtain accurate information when seeking unproven cures and use decision aids for driving. An established Univ. of Ks. multidisciplinary team will conduct the study with a subcontract with the Univ. of Wisc. The long-term goal of this proposed study is to validate a CPAP adherence support system that will ultimately improve patient and family caregiver quality of life and public safety, as well as reduce patient and family caregivers' morbidity and the 100 billion dollars spent annually on non-adherence.