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

摘要 美国的拉美裔成年人(美国)罹患阿尔茨海默病(AD)的可能性是普通人的1.5倍 相关痴呆症(ADRD)与非西班牙裔白人成年人的比较。阻塞性睡眠呼吸暂停(OSA)影响 9.8%的拉丁裔成年人，并使诊断为AD的风险增加五倍5。后果也延伸到 床伴，作为阻塞性睡眠呼吸暂停综合症患者的床伴，会经历严重的睡眠障碍，包括睡眠 四分五裂，失眠风险增加3倍。考虑到OSA和OSA之间牢固的机械联系 失眠和ADRD风险，有效的OSA治疗有可能促进健康的认知老化和 降低合作伙伴双方的ADRD风险。而阻塞性睡眠呼吸暂停的一线治疗，即呼吸道正压(PAP)， 在减少OSA症状方面非常有效，并可能减少或预防ADRD风险，其潜力是严重的 减少，因为高达80%的患者没有依从性。现有的PAP依从性干预措施仅限于 他们只关注个体，忽视了床伴在治疗中的作用， 主要在非西班牙裔白人群体中发展。因此，迫切需要发展 循证和文化适应的干预措施，解决阻塞性睡眠呼吸暂停及其治疗对 合作伙伴，并在文化定制的框架内。此R61/33提案的目标是开发和 测试“Nuestro Sueño”，一种文化适应的干预措施，以促进PAP的坚持和睡眠 拉丁裔夫妇的健康。该提案建立在我们团队最近完成的R21基础上，并对其进行了扩展 名为“WePAP”的项目，这是一个简短的(3节)远程健康干预，旨在促进PAP的遵守和睡眠健康 在患有阻塞性睡眠呼吸暂停综合征的夫妇中。试点数据表明，我们的干预是可行的、可以接受的，并显示出希望 用于改善患者和伴侣的依从性、睡眠、关系质量和认知功能。因此， 在接下来的步骤中，我们建议1)对Nuestro进行严格的文化适应和测试过程 Sueño，利用社区咨询委员会、患者/伴侣焦点小组和现场测试的意见和2) 进行随机临床试验，评价其可行性、治疗满意度和初步疗效。 Nuestro Sueño与信息控制(IC)在80名OSA患者及其伴侣(即40名)样本中的比较 两个地点(犹他州和亚利桑那州)。干预措施特别侧重于 使用干预材料增强二元性应对和沟通的人际机制 与文化信仰和价值观产生共鸣。如果成功，Nuestro Sueño，一个创新和文化适应的 干预，有可能显著推进OSA的治疗，并可能阐明一种关键的， 可修改的预防和干预目标，以促进健康老龄化和减少ADRD风险差异 在拉丁裔夫妇中。

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.