Adherence with Sleep Apnea Treatments: A Meta-Analysis

描述(申请人提供)：据估计，美国有7000万人患有睡眠问题，其中超过一半的人患有慢性睡眠障碍。睡眠问题和障碍具有重大的社会影响，包括昏昏欲睡的驾驶事故和死亡、生产力下降和高昂的成本。2003年国家睡眠障碍研究计划和最近的一次NIH研讨会提出的关键研究建议之一是更好地了解睡眠障碍的治疗，包括坚持这些治疗，以便为改善睡眠障碍的管理提供循证指南。最常见的睡眠障碍是睡眠相关呼吸障碍(SRBD)，特别是阻塞性睡眠呼吸暂停(OSA)。SRBD的治疗方案包括医疗器械、口腔用具和行为建议。当个人没有成功地执行其健康专业人员提出的健康行为建议时，就会发生不遵守，这是一种普遍的行为问题，会导致浪费医疗保健访问、昂贵且危险的医疗并发症、治疗失败以及错过改善和保持生活质量的机会。国家医学图书馆的数据库包含来自世界各地发表的关于SRBD治疗依从性的科学期刊文章，但对于如何最好地解决这一严重的、主要是行为问题，几乎没有基于经验的共识。这个项目将系统地搜索PubMed数据库(补充了心理信息和Cochrane中央受控试验登记)，并使用荟萃分析技术来组织、量化总结和统计整合所有已发表的实证研究的结果，分析所有相关、决定因素和患者对医疗保健提供者提供的SRBD干预措施的依从性(遵从性)的后果。将使用一个有组织的、基于经验的解释因素框架，该框架捕捉到对患者对SRBD管理的许多不同方面的依从性的广泛影响。计算多个概念驱动的荟萃分析将需要收集和统计效应大小，并将有助于建立直接的数据驱动模型，以实现对患者依从性的详细理解，将其作为健康结果的中介。该项目的目标是确定必要的未来研究战略和具有最大潜力的行为干预因素，以提高SRBD患者的依从性并改善健康结果。

DESCRIPTION (PROVIDED BY APPLICANT): An estimated 70 million people in the United States suffer from sleep problems, and more than half of them have a sleep disorder that is chronic. Sleep problems and disorders have major societal impacts including drowsy driving accidents and deaths, lost productivity, and high costs. One of the key research recommendations put forth by both the 2003 National Sleep Disorders Research Plan and a recent NIH workshop is a better understanding of sleep disorders treatments, including adherence to those treatments, in order to inform evidence-based guidelines for the improved management of sleep disorders. The most prevalent class of sleep disorders are Sleep-Related Breathing Disorders (SRBD), and in particular, obstructive sleep apnea (OSA). SRBD treatment regimens include medical devices, oral appliances, and behavioral recommendations. Nonadherence (noncompliance) occurs when individuals do not successfully carry out the health behavior recommendations made by their health professionals, and is a widespread behavioral problem that results in wasted health care visits, expensive and dangerous medical complications, failures of treatment, and missed opportunities to improve and maintain quality of life. The databases of the National Library of Medicine contain scientific journal articles published from all over the world on SRBD treatment adherence yet there exists little empirically based consensus regarding how best to solve this serious, largely behavioral problem. This project will systematically search the PubMed database (supplemented by PsyInfo and the Cochrane Central Register of Controlled Trials) and use the techniques of meta-analysis to organize, quantitatively summarize, and statistically integrate the results of all published empirical research analyzing all correlates, determinants, and consequences of patient adherence (compliance) to interventions for SRBD that are given by healthcare providers. An organized, empirically-based framework of explanatory factors that capture the broad range of influences on patient adherence to many varying aspects of SRBD management will be used. Calculation of multiple, conceptually driven meta-analyses will entail the collection and statistical combination of effect sizes, and will contribute to the building of straightforward data-driven models to achieve a detailed understanding of patient adherence as a mediator of health outcomes. The goal of the project is to identify necessary future research strategies and factors with the greatest potential for behavioral intervention to increase adherence and improve health outcomes for SRBD patients.