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，减少睡眠健康差异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）对黑人的影响尤为严重，它是一种重要的可预防和/或可治疗的疾病，应予以关注，因为它与心血管风险增加和疾病结局（包括肥胖、糖尿病、高血压、中风、心律失常和慢性心力衰竭）有关。我们在高危黑人中进行的社区焦点小组研究结果表明，大多数人不知道睡眠呼吸暂停症状或与呼吸暂停相关的心血管疾病。参与我们研究的黑人中只有26%的人遵守了推荐的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，但在实验室接受评估的人中，有90%被诊断为睡眠呼吸暂停。在一项两组随机对照试验中，我们将确定同伴睡眠健康教育和社会支持在提高398名有OSA风险的黑人的OSA评估和治愈率方面的有效性。干预组的黑人将接受有质量控制的、根据文化和语言量身定制的同伴教育，使用根据动机增强原则制定的睡眠健康教育手册。在6个月的时间里，他们每人将接受多达4次关于OSA筛查的培训。诊断为阻塞性睡眠呼吸暂停的患者将接受2个额外的会议，以促进阻塞性睡眠呼吸暂停治疗的依从性，并结合电话干预和基于网络报告的阻塞性睡眠呼吸暂停导航员治疗依从性差的情况。注意控制组只接收标准的OSA文献。无论分组如何，我们将在基线和6个月和12个月的随访评估中确定所有结果。我们还将使用家庭录音来评估该人群的阻塞性睡眠呼吸暂停率。个体层面的因素（即OSA知识、自我效能、准备程度和过去的筛查行为）和情境层面的因素（即与同伴教育者的信任/关系、家庭网络和社会经济地位）在干预对依从状态的中介效应中的影响将被确定。长期目标是将这种干预方式应用于社区环境（理发店、美容院、教堂和健康中心），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、非传统的模式，在全国黑人中传播这种降低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1.8万家黑人理发店和1.3万家黑人教堂。

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.