Cognitive Behavioral Therapy to Increase CPAP Adherence in Veterans with PTSD

认知行为疗法可提高患有 PTSD 的退伍军人对 CPAP 的依从性

• 批准号: 9918161
• 负责人: Lisa M. Kinoshita
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9918161
• 关键词: Address; Adherence; Aging; American; Analysis of Covariance; Appointment; Arts; Auditory; Award; Caring; Chronic; Clinical; Clinical Research; Clinical Trials; Cognition; Cognitive; Cognitive Therapy; Complex; Continuous Positive Airway Pressure; DSM-V; Data; Data Analyses; Data Set; Databases; Dementia; Deterioration; Development; Diagnosis; Doctor of Philosophy; Elderly; Environment; Epidemiology; Evidence based practice; Fostering; Gender; Goals; Health; Healthcare Systems; Hour; Hypoxemia; Impaired cognition; Individual; Individual Differences; International; Intervention; Lead; Longevity; Lung; Masks; Measures; Mediating; Mediator of activation protein; Medical; Medicine; Memory; Moods; Myocardial Infarction; Obesity; Obstructive Sleep Apnea; Outcome; Participant; Patient Self-Report; Patients; Physicians; Post-Traumatic Stress Disorders; Protocols documentation; Provider; Psychiatrist; Psychologist; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recurrence; Rehabilitation therapy; Reporting; Research; Research Design; Research Personnel; Resources; Respiratory Signs and Symptoms; Respiratory Therapy; Risk; Risk Factors; Sampling; Scientist; Self Efficacy; Services; Severities; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep Fragmentations; Sleeplessness; Smoking; Source; Specialist; Statistical Data Interpretation; Stroke; Symptoms; Techniques; Testing; Therapeutic Intervention; Time; Training; Verbal Learning; Veterans; Vietnam; Visit; War; Work; arm; barrier to care; behavior change; clinical trial analysis; comorbidity; daily functioning; design; disability; epidemiology study; functional disability; functional outcomes; improved; improved outcome; intervention effect; male; middle age; nerve injury; non-compliance; novel; patient oriented; physical conditioning; post intervention; primary endpoint; programs; psychologic; public health relevance; rehabilitation research; research and development; response; screening; software systems; standard of care; trauma exposure; treatment adherence; treatment as usual

 DESCRIPTION (provided by applicant): This is an application for a VA Rehabilitation Research and Development (RR&D) Merit Review Award submitted by Lisa M. Kinoshita, Ph.D. Dr. Kinoshita is currently a Staff Clinical Psychologist at the VA Palo Alto Health Care System with a current 6/8ths VA appointment. Dr. Kinoshita is an established clinician- scientist who conducts patient-centered clinical research on PTSD, obstructive sleep apnea (OSA) and cognition. This award will provide Dr. Kinoshita and her research team with the resources necessary to develop a novel cognitive-behavioral therapy intervention for PTSD Veterans with OSA (CBT-OSA) to increase adherence to continuous positive airway pressure (CPAP) treatment, the standard of care for OSA treatment. To accomplish this goal, she has gathered a team that includes seven Co-Investigators: Dr. Jerome Yesavage (a geriatric psychiatrist and renowned expert in cognitive and psychiatric functioning across the lifespan); Dr. Ware Kuschner (a Board Certified Sleep Medicine physician and a specialist in sleep and sleep disordered breathing); Dr. Jon-Erik Holty (a Board Certified Sleep Medicine physician and a specialist in the diagnosis and treatment of OSA); Dr. Clete Kushida (a Board Certified Sleep Medicine physician and an expert in clinical trials related to sleep disorders and a specialist in the diagnosis and treatment of sleep disorders); Dr. Jauhtai Cheng (a Board Certified Sleep Medicine physician and an expert in the diagnosis of OSA); Dr. Joy Taylor (a cognitive psychologist and expert in the trajectory of cognitive decline); and Dr. Leah Friedman (an expert in sleep and aging and CBT interventions for insomnia and memory); and a team of consultants: Dr. Kristine Yaffe (an internationally renowned expert in sleep disorders, PTSD, aging, cognition and epidemiology); Dr. Craig Rosen (a Clinical Psychologist with an expertise in PTSD diagnosis and treatment, including evidence- based practices); Dr. Donn Posner (a Clinical Psychologist with an expertise in CBT for insomnia and other sleep disorders); Dr. Laura Lazzeroni (a biostatistician with expertise in design/analysis of clinical trials, longitudinal data analysis, and missing data analysis); and Art Noda (a data analyst and database manager with extensive background using Statistical Analysis System (SAS) software, database construction and complex statistical analysis). The purpose of this proposal is to test a novel cognitive-behavioral therapy (CBT) intervention to increase CPAP treatment adherence for PTSD Veterans with a new diagnosis of OSA. [A total of 120 Veterans with PTSD and OSA will be randomized to CBT-OSA or to the RT-only arm.] Intervention effects will be examined at time points during and post-intervention throughout the 1-year study. The Primary Aim of this study is to examine the efficacy of CBT-OSA in increasing the average hours per night of CPAP use. Dr. Kinoshita will also use advanced statistical techniques to evaluate the impact of the CBT-OSA intervention on: daily functioning, mood and quality of life (Specific Aim 2); cognition (Specific Aim 3); and PTSD symptoms (Specific Aim 4) in Veterans with PTSD. This award will create an ideal environment where Dr. Kinoshita and her research team can establish the necessary efficacy data for this novel CBT-OSA treatment. If the intervention is successful, the CBT-OSA treatment may be disseminated to providers within VHA through VA's Evidence-Based Practices (EBP) national roll-out program.

 描述（由申请人提供）： 这是丽莎M提交的VA康复研究和发展（RR&D）优秀评审奖的申请。Kinoshita博士Kinoshita博士目前是VA Palo Alto医疗保健系统的临床心理学家，目前有6/8的VA任命。木下博士是一位成熟的临床科学家，他对创伤后应激障碍、阻塞性睡眠呼吸暂停（OSA）和认知进行以患者为中心的临床研究。该奖项将为Kinoshita博士和她的研究团队提供必要的资源，为患有OSA的PTSD退伍军人（CBT-OSA）开发一种新的认知行为治疗干预，以提高对持续气道正压通气（CPAP）治疗的依从性，这是OSA治疗的护理标准。为了实现这一目标，她组建了一个包括七名合作研究者的团队：杰罗姆耶萨维奇博士（老年精神病学家，认知和精神功能方面的知名专家）; Ware Kuschner博士（委员会认证的睡眠医学医生和睡眠和睡眠呼吸障碍专家）; Jon-Erik Holty博士（委员会认证的睡眠医学医生和OSA诊断和治疗专家）; Clete Kushida博士（委员会认证的睡眠医学医生和睡眠障碍相关临床试验专家以及睡眠障碍诊断和治疗专家）;郑兆泰博士（委员会认证的睡眠医学医生和OSA诊断专家）;乔伊·泰勒博士（认知心理学家和认知衰退轨迹专家）;和利亚弗里德曼博士（睡眠和衰老以及失眠和记忆的CBT干预专家）;和一个顾问团队：Kristine Yaffe博士（国际知名的睡眠障碍、创伤后应激障碍、衰老、认知和流行病学专家）;克雷格罗森博士（一名临床心理学家，具备创伤后应激障碍诊断和治疗的专业知识，包括循证实践）; Donn Posner博士（临床心理学家，擅长失眠和其他睡眠障碍的CBT）; Laura Lazzeroni博士（生物统计学家，具有临床试验设计/分析、纵向数据分析和缺失数据分析方面的专业知识）;和Art Noda（数据分析师和数据库管理员，具有使用统计分析系统（SAS）软件、数据库构建和复杂统计分析的广泛背景）。该提案的目的是测试一种新的认知行为疗法（CBT）干预，以增加新诊断为OSA的PTSD退伍军人的CPAP治疗依从性。[共有120名患有PTSD和OSA的退伍军人将被随机分配到CBT-OSA或仅RT组。将在整个1年研究期间和干预后的时间点检查干预效果。本研究的主要目的是检查CBT-OSA在增加每晚使用CPAP的平均小时数方面的有效性。Kinoshita博士还将使用先进的统计技术来评估CBT-OSA干预对以下方面的影响：日常功能，情绪和生活质量（具体目标2）;认知（具体目标3）;和创伤后应激障碍症状（具体目标4）。该奖项将创造一个理想的环境，Kinoshita博士和她的研究团队可以为这种新型CBT-OSA治疗建立必要的疗效数据。如果干预是成功的，CBT-OSA治疗可以通过VA的循证实践（EBP）国家推广计划传播给VHA内的提供者。