Adherence with Sleep Apnea Treatments: A Meta-Analysis

描述（由申请人提供）：据估计，美国有7000万人患有睡眠问题，其中一半以上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，包括疲劳驾驶事故和死亡、生产力损失和高成本。2003年国家睡眠障碍研究计划和最近的NIH研讨会提出的关键研究建议之一是更好地理解睡眠障碍的治疗方法，包括坚持这些治疗方法，以便为改善睡眠障碍的管理提供循证指导。最常见的睡眠障碍是睡眠相关呼吸障碍（SRBD），尤其是阻塞性睡眠呼吸暂停（OSA）。SRBD的治疗方案包括医疗器械、口腔器械和行为建议。当个人没有成功地执行其卫生专业人员提出的健康行为建议时，就会出现不遵守（不遵守），这是一个普遍存在的行为问题，导致浪费医疗保健就诊，昂贵和危险的医疗并发症，治疗失败以及错过改善和保持生活质量的机会。美国国家医学图书馆的数据库包含了来自世界各地的关于SRBD治疗依从性的科学期刊文章，但关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。本项目将系统地检索PubMed数据库（由PsyInfo和Cochrane中央对照试验注册库补充），并使用荟萃分析技术对所有已发表的实证研究结果进行组织、定量总结和统计整合，分析所有相关因素、决定因素和患者依从性（依从性）的后果，这些结果是由医疗服务提供者给出的SRBD干预措施。将使用一个有组织的、基于经验的解释因素框架，该框架涵盖了对患者遵守SRBD管理许多不同方面的广泛影响。计算多个概念驱动的元分析将需要收集和统计效应大小的组合，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作为健康结果中介的详细理解。该项目的目标是确定未来必要的研究策略和因素，这些策略和因素具有最大的行为干预潜力，以提高SRBD患者的依从性和改善健康结果。

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.