Diagnosis and Treatment of Sleep Apnea in Women Veterans

女性退伍军人睡眠呼吸暂停的诊断和治疗

• 批准号: 9655231
• 负责人: Jennifer L Martin
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9655231
• 关键词: Accounting; Address; Adherence; Adopted; Anxiety; Area; Behavioral; Cardiovascular Diseases; Caring; Cause of Death; Clinical Management; Clinical Trials; Cognitive Therapy; Data; Diagnosis; Diagnostic; Disease; Drowsiness; Education; Fatigue; General Population; Goals; Health; Heart Diseases; Hour; Hypertension; Hypothyroidism; Intention; Intervention; Link; Literature; Measures; Mental Depression; Methods; Modeling; Monitor; Motivation; Outcome Study; Patient Education; Patient Self-Report; Patients; Population; Psychotherapy; Publishing; Quality of life; Randomized Controlled Trials; Recommendation; Reporting; Research; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep disturbances; Sleeplessness; Snoring; Statistical Methods; Techniques; Testing; Therapeutic; Veterans; Woman; Women' s Health; Work; adherence rate; adverse outcome; base; blood pressure reduction; depressive symptoms; design; efficacy testing; evidence base; experience; functional disability; high risk; improved; learning strategy; men; mindfulness; mortality; mortality risk; novel; preference; pressure; programs; psychologic; reduce symptoms; sleep quality; social factors; therapy adherence; treatment as usual; vehicular accident

Sleep disordered breathing (SDB) is associated with significant adverse health consequences including cardiovascular disease, motor vehicle accidents, daytime functional impairments and mortality risk. Although SDB is more common among men than women, it still impacts 17% of women in the general population. [Our preliminary evidence suggests it is even more common among women Veterans who receive VA care.] The recommended first-line therapy for most patients with SDB is positive airway pressure therapy (PAP). Published studies show that women have lower PAP adherence than men, particularly in the US, yet we are not aware of data comparing men and women Veterans. Because women Veterans experience significant sleep disturbance and other consequences of sleep disorders, adjusting to PAP therapy may be quite difficult. To date, studies have not tested interventions specifically designed to improve PAP adherence among women, accounting for important sleep-related and social factors. Since 2010 we have been studying sleep disorders among women Veterans, initially focusing on insomnia disorder. Through this work we discovered that a significant segment of women served by VA also are high risk for sleep disordered breathing (SDB; also referred to as sleep apnea), particularly if they report poor sleep. In treating insomnia, we found that the initial discomfort created by traditional cognitive-behavioral therapy for insomnia (e.g. initial sleep restriction) is difficult for many women Veterans to tolerate. We developed and are now testing an insomnia intervention based on Acceptance and Commitment Therapy (ACT), called “Acceptance and the Behavioral Changes to Treat Insomnia” or “ABC-I”. Within ACT, treatment focuses on a patient's values and reasons for implementing behavioral changes, and teaches the patient strategies for tolerating temporary discomfort in pursuit of goals consistent with one's values. We now propose to use these same therapeutic approach, adopted from ACT, to address unique challenges faced by women Veterans in adjusting to PAP therapy. This study is a randomized controlled trial (RCT) to test the efficacy of a program combining patient education with ACT-based techniques in improving adherence to PAP therapy, called “ABC-SA” or “Acceptance and the Behavioral Changes to treat Sleep Apnea.” This 6-session intervention will address initial discomfort, link treatment to the patient’s values and incorporate methods for accepting the changes that are required to treat SDB. Main study outcomes will be assessed 3 months after PAP initiation, and PAP adherence will be tracked remotely for 12 months. The 6-session “control” intervention will account for the contact with a study interventionist and will be modeled after usual care. The objectives of this proposal are: (1) to test the efficacy of the ABC-SA program in improving PAP adherence, compared to a control program modeled after usual care, for women Veterans with SDB; (2) to test the efficacy the ABC-SA program for improving objectively-measured and patient-reported sleep quality, compared to the control program; and (3), to test the efficacy the ABC-SA program for improving quality of life and symptoms of depression, compared to the control program. Data will be analyzed using “intention to treat” principles, using appropriate statistical methods for clinical trials.

睡眠障碍呼吸(SDB)与严重的不良健康后果有关，包括 心血管疾病、机动车事故、日间功能障碍和死亡风险。虽然 性传播疾病在男性中比在女性中更常见，在总人口中仍有17%的女性受到影响。[我们的 初步证据表明，这种情况在接受退伍军人护理的女性退伍军人中更为常见。]这个 对于大多数SDB患者，推荐的一线治疗是正压治疗(PAP)。 已发表的研究表明，女性对PAP的遵守程度低于男性，尤其是在美国，而我们 不知道比较男性和女性退伍军人的数据。因为女性退伍军人经历了重大的 睡眠障碍和其他睡眠障碍的后果，适应PAP治疗可能是相当困难的。 到目前为止，还没有研究测试专门为提高女性对PAP的依从性而设计的干预措施， 考虑到与睡眠有关的重要因素和社会因素。 自2010年以来，我们一直在研究女性退伍军人的睡眠障碍，最初的重点是失眠 无序。通过这项工作，我们发现退伍军人管理局服务的相当一部分女性也是高危人群 对于睡眠呼吸紊乱(SDB；也称为睡眠呼吸暂停)，特别是当他们报告睡眠不佳时。在……里面 治疗失眠，我们发现，传统的认知行为疗法对失眠患者造成的最初不适 失眠(例如，最初的睡眠限制)对许多女性退伍军人来说很难容忍。我们开发了并正在 现在正在测试一种基于接受和承诺疗法(ACT)的失眠干预措施，称为 《接受与行为改变治疗失眠》或《ABC-I》。在ACT内，治疗重点是 患者的价值观和实施行为改变的原因，并教导患者 在追求与自己价值观一致的目标的过程中容忍暂时的不适。我们现在建议使用这些 同样的治疗方法，来自ACT，以解决#年女性退伍军人面临的独特挑战 适应PAP疗法。 这项研究是一项随机对照试验(RCT)，旨在测试联合患者的方案的疗效 以ACT为基础的技术教育，提高对PAP疗法的依从性，称为“ABC-SA”或 “接受与治疗睡眠呼吸暂停的行为改变。”这项为期6天的干预将解决最初的 不适，将治疗与患者的价值观联系起来，并采用接受改变的方法 需要治疗SDB。主要研究结果将在PAP开始后3个月进行评估，PAP 遵守情况将被远程跟踪12个月。为期6个交易日的“控制”干预将解释 与研究干预者联系，并将仿效通常的护理。 这项建议的目标是：(1)测试ABC-SA计划在改善PAP方面的有效性 对患有SDB的女性退伍军人的依从性，与仿照通常护理模式的控制程序相比；(2)测试 ABC-SA计划改善客观测量和患者报告的睡眠质量的有效性， 与控制程序进行比较；以及(3)检验ABC-SA计划对改善生活质量的有效性 以及抑郁症状，与控制组相比。数据将使用“意向治疗”进行分析。 原则，使用适当的统计方法进行临床试验。