Tailored Peer-Based Sleep Health Education and Social Support in Blacks with OSA

描述（由申请人提供）：根据2011年9月召开的NIH研讨会的执行摘要，睡眠健康差异的减少被认为是干预和转化研究的优先领域。阻塞性睡眠呼吸暂停（OSA），不成比例地影响黑人，是一种重要的可预防和/或可治疗的疾病，应该成为目标，因为它与心血管风险和疾病结局增加有关，包括肥胖，糖尿病，高血压，中风，心律失常和慢性心力衰竭。我们在高危黑人中进行的以社区为基础的焦点小组的结果表明，大多数人不知道睡眠呼吸暂停症状或呼吸暂停相关的心血管疾病。只有26%的黑人参与我们的研究坚持推荐的OSA评估，尽管39%的人有OSA的高风险。虽然很少有黑人遵守医生的建议，但在实验室评估的人中有90%接受了睡眠呼吸暂停诊断。在一项两组随机对照试验中，我们将确定基于同伴的睡眠健康教育和社会支持在增加398名有OSA风险的黑人中的OSA评估和治疗率方面的有效性。干预组中的黑人将接受质量控制、文化和语言上量身定制的同伴教育，使用根据动机增强原则开发的睡眠健康教育手册。他们每人将在6个月内接受最多4次促进OSA筛查的会议。诊断为OSA的患者将接受2次额外的会议，以促进OSA治疗依从性，并根据基于网络的报告中的治疗依从性差，使用OSA Navigator进行电话干预。那些在注意力控制组的人只会收到标准的OSA文献。无论分组如何，我们将在基线和6个月和12个月随访评估时确定所有结局。我们还将使用家庭记录评估该人群中OSA的发生率。个人层面因素的影响（即，OSA知识、自我效能、准备和过去的筛查行为）和背景水平因素（即，信任/融洽的同伴教育者，家庭网络，和社会经济地位）的中介干预效果的依从性状态将被确定。长期目标是将这种干预模式应用于社区环境（理发店、美容院、教堂和保健中心），从而将社区健康促进与医疗保健系统联系起来。因此，我们的项目可以作为一种替代的非传统模式，在全国范围内传播这种降低黑人心血管风险的干预措施。传播的潜力很大，因为在美国的城市中心有超过18000家黑人理发店和13000座黑人教堂。

DESCRIPTION (provided by applicant): Reduction in sleep health disparities was recognized as a priority area for intervention and translational research, according to the Executive Summary of the NIH workshop convened in September 2011. Obstructive sleep apnea (OSA), which disproportionately affects blacks, is an important preventable and/or treatable disease that should be targeted as it is associated with increased cardiovascular risk and disease outcomes, including obesity, diabetes, hypertension, stroke, cardiac arrhythmia, and chronic heart failure. Results of our community-based focus groups conducted among at-risk blacks suggest that most are unaware of sleep apnea symptoms or apnea-related cardiovascular morbidity. Only 26% of blacks participating in our studies adhered to recommended OSA evaluation, although 39% were at high risk for OSA. While few blacks adhered to physician's recommendations, 90% of those assessed in the laboratory received a sleep apnea diagnosis. In a two-arm cluster randomized controlled trial, we will ascertain effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at OSA risk. Blacks in the intervention arm will receive quality-controlled, culturally and linguistically tailored peer education using a sleep health education manual developed based on principles of Motivational Enhancement. They will each receive up to 4 sessions promoting OSA screening during a 6-month period. Those with a diagnosis will receive 2 additional sessions promoting OSA treatment adherence, in conjunction with telephonic interventions with an OSA Navigator contingent upon poor treatment adherence from web-based reports. Those in the attention- control arm will only receive standard OSA literature. Regardless of group assignment, we will ascertain all outcomes at baseline and at 6- and 12-month follow-up assessments. We will also assess the rate of OSA in that population using home recordings. Influence of individual-level factors (i.e., OSA knowledge, self-efficacy, readiness, and past screening behavior) and contextual-level factors (i.e., trust/rapport with Peer Educators, family network, and socioeconomic position) in mediating intervention effects on adherence status will be ascertained. The long-term goal is to apply this intervention modality in community-based settings (barbershops, beauty salons, churches, and health centers), thereby linking community health promotion to the healthcare system. Thus, our program could serve as an alternative, non-traditional model to disseminate this intervention for cardiovascular risk reduction in blacks nationwide. The potential for dissemination is high, as there are over 18-thousand black barbershops and 13-thousand black churches in urban centers across the United States.