RURAL DWELLING OLDER ADULTS: CPAP ADHERENCE SUPPORT

阻塞性睡眠呼吸暂停（OSA）是本质上健康的老年人中最普遍和最昂贵的睡眠障碍。阻塞性睡眠呼吸暂停与心血管和神经认知后遗症有关，与交通死亡和其他事故造成的公共安全损失有关，每年造成的损失为430至560亿美元（国家委员会睡眠报告，1993年第1号）。阻塞性睡眠呼吸暂停是通过夜间持续气道正压通气（CPAP）来控制的，这是治疗的选择（国家睡眠委员会报告编号2,1994）。本随机临床试验的主要目的是确定168例农村老年OSA患者CPAP通气综合干预的长期依从性、健康状况、生活质量和成本效益。依从性通过微处理器压力传感器计时器/记录器作为患者每晚使用CPAP的小时数来测量。次要目的是评估CPAP依从性、生活质量、家庭护理、驾驶安全和事故决策辅助工具的使用之间的关系。干预源自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，从自我指导和集中咨询到家庭双向远程医疗监测，允许护士指导CPAP护理，并评估身体和情感障碍，坚持和互联网互动。在本研究中，只有在患者没有坚持CPAP治疗的情况下，才按标准实施干预措施。这些步骤使用音乐和集中图像来启动CPAP习惯，并使其对CPAP的生理和情感益处敏感，并动员家庭克服使用CPAP的障碍。通过互联网，受试者与同伴和专业咨询师联系，参与互动式依从性支持活动，在寻求未经证实的治疗方法时获得准确信息，并在驾驶时使用决策辅助工具。一所老牌的堪萨斯大学。多学科团队将与威斯康星大学签订分包合同进行这项研究。本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，并减少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.