Nuestro Sueno: Cultural Adaptation of a Couples Intervention to Improve PAP Adherence and Sleep Health Among Latino Couples with Implications for Alzheimer’s Disease Risk

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Abstract Latino adults in the United States (U.S.) are 1.5 times more likely to develop Alzheimer’s disease (AD) and related dementias (ADRD) compared to non-Hispanic white adults. Obstructive sleep apnea (OSA) affects 9.8% of Latino adults and confers a five-fold increased risk of AD diagnosis5. Consequences also extend to the bedpartner, as bedpartners of those with OSA experience significant sleep disturbances, including sleep fragmentation and 3 times greater risk of insomnia. Given solid mechanistic links between both OSA and insomnia and ADRD risk, effective OSA treatment has the potential to promote healthy cognitive aging and reduce ADRD risk for both partners. While the front-line treatment for OSA, positive airway pressure (PAP), is highly effective at reducing OSA symptoms and may reduce or forestall ADRD risk, its potential is severely diminished, as up to 80% of patients are non-adherent. Extant PAP adherence interventions are limited in that they are exclusively focused on the individual, neglecting to consider the role of the bedpartner in treatment, and developed primarily in non-Hispanic white populations. Therefore, there is a critical need to develop evidence-based, and culturally-adapted interventions that address the impact of OSA and its treatment on both partners and within a culturally-tailored framework. The goal of this R61/33 proposal is to develop and test “Nuestro Sueño” a culturally-adapted intervention to promote PAP adherence and sleep health among Latino couples. This proposal builds on and extends our team’s recently completed R21 project called “WePAP”, a brief (3 session) telehealth intervention to promote PAP adherence and sleep health among couples with OSA. Pilot data demonstrates our intervention is feasible, acceptable and shows promise for improving adherence, sleep, relationship quality and cognitive function for patient and partners. Therefore, in the next steps, we propose to 1) Conduct a rigorous cultural adaptation and testing process of Nuestro Sueño, utilizing input from a community advisory board, patient/partner focus groups and field testing and 2) Conduct a randomized clinical trial to evaluate the feasibility, treatment satisfaction and preliminary efficacy of Nuestro Sueño versus information control (IC) in a sample of 80 OSA patients and their partners (i.e., 40 couples per treatment arm) across two sites (Utah and Arizona). The intervention focuses specifically on the interpersonal mechanisms of enhancing dyadic coping and communication, using intervention materials resonant with cultural beliefs and values. If successful, Nuestro Sueño, an innovative and culturally-adapted intervention, has the potential to significantly advance the treatment of OSA, and may elucidate a critical, modifiable target of prevention and intervention to promote healthy aging and reduce disparities in ADRD risk among Latino couples.