Personalized OSA treatment and effects on AD biomarkers and cognition among blacks

项目摘要 有证据表明，阻塞性睡眠呼吸暂停患者的tau和淀粉样蛋白-β负荷增加。 在这些患者中，记忆、执行功能、注意力和警觉性的损害也很常见。 幸运的是，OSA治疗可以使阿尔茨海默病(AD)的这些生物标志物正常化并改善 认知功能。治疗还可以减少全身炎症，改善胰岛素敏感性，改善血液 压力，以及血脂和脂蛋白。尽管有如此令人信服的数据，但人们对 阻塞性睡眠呼吸暂停综合征治疗对黑人的影响，这一群体肩负着阻塞性睡眠呼吸暂停和阿尔茨海默病不成比例的负担。 未能从这些医学进步中受益，部分原因是缺乏解释难以获得 适当的OSA护理，限制了我们在以下方面实施指导积极控制OSA的卫生政策的能力 黑人。我们提出了一项随机对照试验来评估我们创新的个性化OSA治疗的有效性 提高黑人对OSA治疗依从性的依从性模型。我们将实施有效的 和可扩展的干预，以确定阻塞性睡眠呼吸暂停治疗对AD生物标志物和认知功能的影响 以及以患者为中心的结果。首先，我们将利用利益相关者认可的基于网络的睡眠 我们开发的教育平台(TASHE)，展示了患有阻塞性睡眠呼吸暂停综合征的黑人患者的旅程。第二，我们将 使用个性化方法传递视频信息(OSA内容和指导建议)以提高 阻塞性睡眠呼吸暂停综合征的治疗效果。消息将根据患者的具体情况进行个性化处理，以推动 并在他们首选的阻塞性睡眠呼吸暂停综合征护理路径中导航。配置文件将整合患者的基线数据(例如， 人口、医疗、健康素养、动机、变革准备)和收集的新障碍 从对生态瞬时评估的反应。辅导要克服的策略的信息 系统层面的障碍，阻碍了OSA护理路径的成功导航，将使用 激励性增强。新诊断的黑人(n=330，60-85岁)将随机接触 个性化或标准OSA消息(例如，AASM和NSF)。我们将捕获遵从性数据 通过遥测，实现数据驱动的决策规则的实时应用，以优化消息传递。我们 将在基线和注册后6个月确定生物标记物和认知结果。这项研究 团队将：1)评估个性化、基于网络的干预在增加 在新诊断的黑人中坚持接受OSA治疗并保持呼吸道正压；2)确定 阻塞性睡眠呼吸暂停综合征治疗是否改善a)分子AD生物标志物(Hcy、NFL、GFAP、Tau和Aβ)和b) 认知功能(注意力、语言、记忆和执行功能)；以及3)决定OSA是否 治疗改善了患者与健康相关的生活质量、日间功能和睡眠质量。我们预计 个性化OSA治疗依从性模式(PUAD)将对OSA产生重大影响 坚持治疗，改善与阻塞性睡眠呼吸暂停相关的临床和以患者为中心的结果。

Project Summary Evidence shows increased tau and amyloid-β burden among patients with obstructive sleep apnea (OSA). Impairment in memory, executive function, attention, and vigilance is also common among those patients. Fortunately, OSA treatment can normalize these biomarkers of Alzheimer’s disease (AD) and improve cognitive function. Treatment can also reduce systemic inflammation and improve insulin sensitivity, blood pressure, and serum lipids and lipoproteins. Notwithstanding such compelling data, little is known about the impact of OSA treatment among blacks, a group shouldering a disproportionate burden of OSA and AD. Failure to benefit from these medical advances is due in part to a dearth of data explaining poor access to adequate OSA care, limiting our ability to implement health policies guiding aggressive OSA control among blacks. We propose an RCT to assess the effectiveness of our innovative Personalized OSA Treatment Adherence Model in enhancing adherence to OSA treatment among blacks. We will implement an effective and scalable intervention to ascertain effects of OSA treatment on AD biomarkers and cognitive function as well as patient-centered outcomes. First, we will leverage a stakeholder-endorsed, web-based sleep education platform (TASHE) we developed, featuring journeys of black patients with OSA. Second, we will use a personalized approach for delivering video messages (OSA content & coaching advice) to increase OSA treatment self-efficacy. Messages will be personalized based on patients’ idiographic profile to nudge and navigate them in their preferred OSA care pathway. Profiles will integrate patients’ baseline data (e.g., demographic, medical, health literacy, motivation, readiness to change) and the emergent barriers gleaned from responses to ecological momentary assessment. Coaching messages about strategies to overcome system-level barriers, impeding successful navigation of the OSA care pathway will be delivered using Motivational Enhancement. Newly diagnosed blacks (n=330, 60-85 years) will be randomly exposed to either the personalized or standard OSA messages (e.g., AASM & NSF). We will capture adherence data via telemetry, enabling real-time application of data-driven decision rules to optimize message delivery. We will ascertain biomarker and cognitive outcomes at baseline and at 6 months post-enrollment. The study team will: 1) assess the comparative effectiveness of the personalized, web-based intervention in increasing adherence to OSA treatment with Positive Airway Pressure among newly diagnosed blacks; 2) determine whether OSA treatment improves a) molecular AD biomarkers (Hcy, NFL, GFAP, Tau and Aβ) and b) cognitive function (attention, language, memory, and executive function); and 3) determine whether OSA treatment improves patients’ health-related quality of life, daytime functioning, and sleep quality. We expect the Personalized OSA Treatment Adherence Model (PRAISE) will have a significant impact on OSA treatment adherence, leading to improved OSA-related clinical and patient-centered outcomes.