Enhancing Motivation for CPAP Adherence in Obstructive Sleep Apnea

描述(由申请人提供)：我的研究计划的首要目标是通过优化睡眠障碍的治疗来改善慢性病患者的结果。持续气道正压(CPAP)治疗阻塞性睡眠呼吸暂停(OSA)是一种有效的治疗方法，但依从性差。到目前为止，动机增强(ME)疗法是最有希望提高对CPAP依从性的方法，但通过增加对患者的支持和替代干预交付的策略，干预将得到优化。重要他人(SO)可能对患者接受和使用CPAP产生积极和消极影响，经常被描述为慢性病患者最大的社会支持来源。在CPAP开始前开始干预将利用诊断后不久的可教时刻，此时动力和社会支持可能是最重要的。研究计划的第一个目的是利用定性研究方法(焦点小组)探索患者和SOS采用和使用CPAP的关键因素；并根据从焦点小组获得的信息和将SOS纳入干预会议，修改针对CPAP的简短动机干预。第二个目的是进行一项随机对照的初步研究，以检验改进的动机干预对CPAP依从性的影响，以及CPAP依从性与健康结果(例如，日间嗜睡、睡眠相关功能状态、自我报告的用药依从性和血压)之间的关系。先导研究中的患者将被随机分为干预组、注意力控制组或标准临床护理组。为了实现这项研究计划的目标，以及我成为一名开发针对睡眠障碍治疗坚持的行为干预措施的独立研究员的长期目标，我需要在以下领域进行进一步的培训：(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发展，(3)CPAP坚持方法、评估和分析，以及(4)设计和进行随机临床试验的方法学和统计技术。这项提议提供了一种改进CPAP遵从性的创新方法，并有可能对当前的干预战略产生重大影响，这些干预战略旨在提高对日益普遍的公共卫生问题有效治疗的遵从性。

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.