RURAL DWELLING OLDER ADULTS: CPAP ADHERENCE SUPPORT

阻塞性睡眠呼吸暂停（OSA）是基本健康的老年人中最普遍和最昂贵的睡眠障碍。 OSA与心血管和神经认知后遗症以及由于交通死亡和其他事故造成的公共安全损失有关，每年花费430亿至560亿美元（National Commission Sleep Report，第1号，1993）。 OSA通过夜间持续气道正压通气（CPAP）来控制，这是治疗的选择（国家睡眠委员会报告第2号，1994）。 这项随机临床试验的主要目的是确定168名农村老年OSA患者CPAP通气综合干预的长期依从性、健康、生活质量结局和成本效益。通过微处理器压力传感器计时器/记录器测量夜间CPAP使用的患者小时数。 次要目的是评估CPAP依从性、生活质量、家庭团聚、使用驾驶安全辅助决策和事故之间的关系。 干预措施来自Triandis和Smith模型，每个干预步骤都在老年人中进行了测试。 干预步骤的强度逐渐增加，从自我导向和集中的咨询到家庭双向远程健康监测，允许护士指导CPAP护理并评估身体和情感障碍，以坚持和互联网互动。 只有当患者不遵守规定的CPAP治疗时，才按照标准实施本拟议研究中的干预步骤。 这些步骤使用音乐和集中的图像来启动CPAP习惯，并对CPAP的生理和情感益处进行敏感化，并动员家庭克服CPAP使用的障碍。 通过互联网，受试者连接到同行和专业顾问，参与互动的坚持支持活动，在寻求未经证实的治疗方法时获得准确的信息，并使用决策辅助工具进行驾驶。 一个建立的大学KS。一个多学科小组将与威斯康星大学的一个研究小组一起进行这项研究。 这项拟议研究的长期目标是验证CPAP依从性支持系统，该系统最终将改善患者和家庭护理人员的生活质量和公共安全，并降低患者和家庭护理人员的发病率和每年花费在不依从性上的1000亿美元。

Obstructive Sleep Apnea (OSA) is the most prevalent and costly sleep disorder in essentially healthy older adults. OSA is assoicated with cardiovascular and neurocognitive sequaela and with public safety losses due to traffic fatalities and other accidents that cost 43 to 56 billion dollars annually (National Commission Sleep Report, number 1, 1993). OSA is controlled with nightly Continuous Positive Airway Pressure (CPAP) ventilation, the treatment of choice (National Commission on Sleep Report number 2, 1994). The primary aim of this randomized clinical trial is to determine the long-term adherence, health, quality of life outcomes, and cost-benefit of a comprehensive intervention on CPAP ventilation in 168 rural dwelling older adults with OSA. Adherence is measured by microprocessor pressure-sensor timer/recorder as patient hours of nightly CPAP use. The Secondary Aim is to assess relationships among CPAP adherence, quality of life, family caregiving, use of a decision aid for driving safety and accidents. The intervention was derived from Triandis and Smith models and each intervention step has been tested in older adults. The intervention steps gradually increase in intensity from self-directed and focused counseling to in home 2-way telehealth monitoring that allows a nurse to direct CPAP care and assess for physical and emotional barriers to adherence and internet interaction. Intervention steps in this proposed study are administered per criteria only if the patient is not adhering to the prescribed CPAP treatment. The steps use music and focused imagery for CPAP habit initiation and sensitization to physiologic and affective benefits from CPAP and mobilizing the family to overcome barriers to CPAP use. Through the internet, subjects connect to peer and professional counselors, engage in interactive adherence support activities, obtain accurate information when seeking unproven cures and use decision aids for driving. An established Univ. of Ks. multidisciplinary team will conduct the study with a subcontract with the Univ. of Wisc. The long-term goal of this proposed study is to validate a CPAP adherence support system that will ultimately improve patient and family caregiver quality of life and public safety, as well as reduce patient and family caregivers' morbidity and the 100 billion dollars spent annually on non-adherence.