Enhancing Motivation for CPAP Adherence in Obstructive Sleep Apnea

描述（由申请人提供）：我的研究计划的总体目标是通过优化睡眠障碍的治疗来改善慢性疾病患者的预后。持续气道正压通气（CPAP）治疗是治疗阻塞性睡眠呼吸暂停（OSA）的有效方法，但依从性差。动机增强（ME）治疗是迄今为止最有前途的方法，用于改善CPAP的依从性，但通过增加对患者的支持和干预措施的替代策略，可以优化干预措施。重要他人（SO）可能会对患者采用和使用CPAP产生积极和消极的影响，并且经常被描述为慢性病患者社会支持的最大来源。在CPAP启动前开始干预将利用诊断后不久的可教时刻，此时动机和社会支持可能是最重要的。研究计划的第一个目的是探索采用和使用CPAP的患者和SO使用定性研究方法（焦点小组）的关键因素;并修改一个简短的动机干预CPAP的基础上获得的信息从焦点小组和纳入SO的干预会议。第二个目的是进行随机对照试点研究，以检查改良的动机干预对CPAP依从性的影响以及CPAP依从性与健康结果之间的关系（例如，白天嗜睡、睡眠相关的功能状态、自我报告的药物依从性和血压）。初步研究中的患者将被随机分配至干预组、注意力控制组或标准临床护理组。为了实现本研究计划的目标以及我成为一名独立研究人员的长期目标，开发针对睡眠障碍治疗依从性的行为干预措施，我需要在以下领域进行进一步培训：（1）睡眠障碍治疗，（2）结合动机访谈技术和夫妇水平方法的行为干预开发，（3）CPAP坚持方法、评估和分析，（4）设计和实施随机临床试验的方法学和统计学技术。该提案提供了一种创新的方法来提高CPAP的依从性，并有可能对当前的干预策略产生重大影响，以提高对日益普遍的公共卫生问题的有效治疗的依从性。

DESCRIPTION (provided by applicant): The overarching goal of my program of research is to improve outcomes in patients with chronic disease by optimizing treatment for sleep disorders. Continuous positive airway pressure (CPAP) therapy is an effective treatment for obstructive sleep apnea (OSA), but adherence is poor. Motivational enhancement (ME) therapy is the most promising approach, to date, for improving adherence to CPAP, but the intervention would be optimized by added support for patients and alternative strategies for intervention delivery. Significant others (SO) are likely to exert positive and negative effects on the patient's adoption and use of CPAP and are frequently described as the greatest source of social support for patients with chronic illness. Beginning the intervention before CPAP initiation would capitalize on the teachable moment shortly following diagnosis when motivation and social support may be most essential. The first aim of the research plan is to explore critical factors for adoption and use of CPAP by both patients and SOs using qualitative research methods (focus groups); and to modify a brief motivational intervention for CPAP based on information obtained from the focus groups and incorporation of SOs in the intervention sessions. The second aim is to conduct a randomized controlled pilot study to examine the effects of the modified motivational intervention on CPAP adherence and the relationship between CPAP adherence and health outcomes (e.g., daytime sleepiness, sleep-related functional status, self-reported medication adherence, and blood pressure). Patients in the pilot study will be randomized to the intervention, attention control, or standard clinical care group. To achieve the goals of this research plan and my long-term goal of becoming an independent researcher developing behavioral interventions targeting adherence to sleep disorder treatments, I require further training in the following areas: (1) sleep disorder treatments, (2) behavioral intervention development incorporating motivational interviewing techniques and couple level approaches, (3) CPAP adherence methodology, assessment, and analysis, and (4) methodological and statistical techniques in designing and conducting randomized clinical trials. This proposal offers an innovative approach to improving CPAP adherence and has the potential to make a significant impact on current intervention strategies for improving adherence to an efficacious treatment in an increasingly prevalent public health problem.