Risk Assessment and Tailored Intervention to Improve CPAP Adherence

对CPAP依从性差是阻塞性睡眠呼吸暂停患者的一个严重问题，导致健康状况不佳和 功能结果。虽然数量很少，但测试干预措施以改善CPAP的研究 在选定的样本中，坚持使用的效果相对较小，而且成本很高。目前还没有已发表的研究 Date专门针对那些不遵守CPAP的高危人群或应用了量身定做的 强化/保留战略以促进CPAP的遵守。拟议研究的总体目标是 检查针对阻塞性睡眠呼吸暂停患者实施CPAP干预的效果、可行性和可接受性 有CPAP不依从性风险的患者。这项拟议的研究将招募高危CPAP未粘附者， 确定治疗前，在试验性随机对照试验中，参与者随机分配到定制的 干预或常规护理(对照)。研究人员开发的量身定制的干预措施基于以下原则 社会认知理论，注重加强患者教育，加强CPAP技能培养，促进早期 对CPAP的积极体验，建立对OSA的早期准确和个性化的认知感知 和CPAP，以及纳入就近的社会支持资源。核心假设是，时机选择得很关键 注重社会文化方面和个人认知的量身定做的干预措施 在OSA诊断和治疗方面的经验将提高潜在患者的总体CPAP依从率 以证明治疗的使用不是最理想的。其具体目标是：(1)确定一个 对阻塞性睡眠呼吸暂停患者在1周、1个月和3个月的CPAP依从性结果进行量身定制的干预， 被确定为后续不坚持的高风险的前处理；以及(2)确定可行性和 定制干预的可接受性，这将指导后续R01的干预改进 申请。这些初步数据将支持设计并成功进行更大规模的随机 对照试验检验量身定制干预的总体有效性。

Poor adherence to CPAP is a significant problem among OSA patients resulting in suboptimal health and functional outcomes. Although few in number, studies that have tested interventions to improve CPAP adherence have shown relatively small effects in selected samples and were costly. No published studies to date have specifically focused on those persons at high risk for nonadherence to CPAP or applied a tailored inten/ention strategy to promote CPAP adherence. The overall objective of the proposed research is to examine the effect, feasibility, and acceptability of a tailored intervention on CPAP adherence among OSA patients at risk for CPAP nonadherence. The proposed study will enroll high risk CPAP nonadherers, identified pre-treatment, in a pilot randomized control trial with participants randomly assigned to a tailored intervention or usual care (control). The investigator-developed tailored intervention is based on tenets of Social Cognitive Theory and focuses on enhanced patient education, CPAP skill-building, promotion of early positive experiences with CPAP, establishing early accurate and personalized cognitive perceptions of OSA and CPAP, and inclusion of proximate social support resources. The central hypothesis is that critically timed tailored interventions that focus on sociocultural aspects and cognitive perceptions of the individual experience with OSA diagnosis and treatment will improve overall CPAP adherence rates among those likely to demonstrate suboptimal use of the treatment. The specific aims are: (1) to determine the effect size of a tailored intervention on CPAP adherence outcomes at 1 week, 1 month, and 3 months among OSA patients, identified pre-treatment, as high risk for subsequent nonadherence; and (2) to determine the feasibility and acceptability of the tailored intervention which will guide intervention refinement for a subsequent R01 application. These preliminary data will support the design and successful conduct of a larger randomized controlled trial testing the overall effectiveness of the tailored intervention.