Optimizing adherence to the treatment of sleep apnea among patients with strokeundergoing inpatient rehabilitation

优化接受住院康复治疗的中风患者对睡眠呼吸暂停治疗的依从性

• 批准号: 10658404
• 负责人: DEVIN L BROWN
• 金额: $ 70.7万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10658404
• 关键词: Address; Adherence; Adult; Affect; Behavior Therapy; Cardiovascular system; Caring; Cessation of life; Clinical Trials; Cognitive; Competence; Continuous Positive Airway Pressure; Control Groups; Counseling; Data; Development; Disease; Effectiveness; Electronic Mail; Event; Exclusion; Feedback; Functional disorder; Funding Opportunities; General Population; Goals; Hand; Health Technology; Impaired cognition; Impairment; Inpatients; Intervention; Interview; Language; Libraries; Monitor; Nature; Obstructive Sleep Apnea; Participant; Patients; Pilot Projects; Process; Protocols documentation; Randomized; Randomized, Controlled Trials; Recovery; Recurrence; Rehabilitation therapy; Research Personnel; Risk; Secure; Self Determination; Self Management; Site; Sleep Apnea Syndromes; Stroke; Stroke prevention; Telephone; Testing; Text; Training; Treatment Efficacy; United States; Work; arm; clinical care; design; disability; effectiveness testing; efficacy evaluation; efficacy testing; follow-up; functional outcomes; group intervention; human centered design; improved; intervention cost; mHealth; motivational enhancement therapy; multi-component intervention; multimodality; pilot trial; post stroke; prevent; primary outcome; programs; skills; stroke intervention; stroke outcome; stroke patient; stroke recovery; stroke survivor; stroke trials; success; tailored messaging; theories

Project Summary/Abstract: The burden of stroke remains unacceptably high and few treatments are proven to improve stroke prevention or recovery. An estimated 70% to 90% of stroke survivors have obstructive sleep apnea (OSA). Compared to those without OSA, stroke patients with OSA have worse functional outcomes after inpatient rehabilitation (IPR), 40% longer IPR stays, a 100% increase in the risk of non-fatal cardiovascular events, particularly recurrent stroke, and a 75% increase in the risk of early death. Observational data suggest that treatment with continuous positive airway pressure (CPAP), the first-line treatment for OSA, holds promise to improve stroke outcomes, including both preventing recurrence and improving recovery. However, poor CPAP adherence has compromised pilot trials of stroke survivors with OSA, yielding mixed results and limiting the ability to test CPAP efficacy. Individualized behavioral interventions to improve CPAP adherence have shown benefit in the general population, though little is known about their effectiveness to optimize CPAP among stroke patients, who are likely to respond to behavioral interventions differently. We propose to adapt and refine for stroke patients a multicomponent behavioral intervention to improve CPAP adherence with the engagement and input of stroke survivors. Then, within a multicenter randomized controlled trial, we will test the efficacy of the intervention, initiated during inpatient rehabilitation, on CPAP use among stroke patients over the course of 3 months. The adherence intervention will include: 1) CPAP technical support, 2) motivational enhancement therapy, and 3) self-monitoring using mobile health technologies with automated support. If successful, the study will provide researchers a much-needed intervention to realize the full benefits of CPAP after stroke. It is difficult to imagine a non-invasive, relatively low-cost intervention with a similar potential as CPAP for such a common and disabling a disease as stroke.

项目概要/摘要： 中风的负担仍然高得令人无法接受，并且很少有治疗被证明可以改善中风预防 或恢复。据估计，70%至90%的中风幸存者患有阻塞性睡眠呼吸暂停（OSA）。相比 无OSA的脑卒中患者，住院康复后OSA患者的功能结局较差 (IPR)，IPR停留时间延长40%，非致命性心血管事件的风险增加100%， 复发性中风，以及75%的早期死亡风险增加。观察数据表明， 持续气道正压通气（CPAP）是OSA的一线治疗方法，有望改善卒中 成果，包括预防复发和改善恢复。然而，CPAP依从性差， 对患有OSA的中风幸存者进行的试点试验受到影响，产生了混合结果，并限制了测试的能力。 CPAP疗效。改善CPAP依从性的个体化行为干预在以下方面显示出益处： 一般人群，尽管对他们在中风患者中优化CPAP的有效性知之甚少， 他们对行为干预的反应可能不同。我们建议调整和完善中风 患者进行多方面的行为干预，以提高CPAP的依从性， 中风幸存者然后，在多中心随机对照试验中，我们将测试 干预，在住院康复期间开始，对卒中患者使用CPAP进行3年 个月依从性干预将包括：1）CPAP技术支持，2）动机增强 治疗，以及3）使用具有自动化支持的移动的健康技术的自我监测。如果成功， 这项研究将为研究人员提供急需的干预措施，以实现中风后CPAP的全部益处。是 很难想象一种非侵入性的，相对低成本的干预措施，具有与CPAP类似的潜力，用于这种疾病。 中风是一种常见的致残性疾病。