Adherence to PAP Treatment: Influences of Co-Morbid Insomnia and of Race/Ethnicity

 描述(申请人提供)：背景：来自临床研究的越来越多的证据表明阻塞性睡眠呼吸暂停(OSA)和失眠之间存在联系，这种共病的患病率从39%到58%不等。此外，合并失眠已经成为一个重要的临床因素，可能会恶化对呼吸道正压(PAP)治疗的坚持，这是诊断为OSA的患者的一线治疗。尽管这些发现提供了重要的洞察力，但它们也并非没有局限性。首先，共病失眠和阻塞性睡眠呼吸暂停综合征患病率的变异性源于评估失眠症状的方法限制，包括未能使用有效的工具。其次，现有的研究大多是在同质样本中进行的，这使得无法评估种族/民族差异，这是理解对PAP治疗依从性差的一个日益令人担忧的问题。研究：这项在K奖范围内的拟议研究将是一个更大的研究计划的第一步，目的是确定导致PAP治疗依从性较差的因素，以及这些因素在黑人和白人患者之间有何不同。这最终将(1)使患有失眠和阻塞性睡眠呼吸暂停综合症的患者能够进行临床分析，(2)确定被诊断为阻塞性睡眠呼吸暂停综合征的黑人患者在坚持PAP治疗方面是否与白人患者不同，以及(3)确定[共患失眠]是否在患者和环境因素之外的[种族/民族和对PAP治疗依从性差]之间的关系中起到中介作用。这项拟议的研究将利用纽约大学和威尔康奈尔睡眠障碍中心的资源来招募[108]名最近被诊断为阻塞性睡眠呼吸暂停综合征的患者，这项研究基于多导睡眠图，这是诊断阻塞性睡眠呼吸暂停综合征的黄金标准。在这些人中，[54人会出现共病失眠，54人没有共病失眠]。多导睡眠图将与睡眠诊所训练有素的工作人员的临床访谈相结合，以分类失眠症状以及 失眠严重程度指数，以及由7天睡眠日记支撑的活动衍生睡眠数据]，以及坚持PAP治疗的客观数据。这项研究的主要结果是坚持PAP超过6个月。培训：K23的这一组成部分由制定拟议研究计划所需的授课和指导经验组成。该培训计划建立在我在少数民族健康教育方面的背景和经验的基础上，并将为我提供必要的睡眠研究、[流行病学]、行为睡眠医学、创新健康干预措施的实施和量化技能方面的培训。教学方法包括一对一的指导、课程工作、有指导的实验室培训，以及参加有针对性的会议和研讨会，所有这些都有一个共同的目标，即支持我转变为一名独立的调查员。

 DESCRIPTION (provided by applicant): Background: Increasing evidence from clinical studies suggests an association between obstructive sleep apnea (OSA) and insomnia, with the prevalence of this comorbidity ranging from 39% to 58%. Further, comorbid insomnia has emerged as an important clinical factor that can worsen adherence to Positive Airway Pressure (PAP) treatment, which is the first-line of treatment for patients diagnosed with OSA. Although these findings provide important insight, they are not without limitations. First, the variability n the prevalence of comorbid insomnia and OSA results from methodological limitations in assessing insomnia symptoms, including a failure to use validated tools. Second, existing studies are largely conducted in homogenous samples, making it impossible to assess racial/ethnic disparities, which is a growing concern in understanding poor adherence to PAP treatment. Research: The proposed study within this K-Award, which will be the first step in a larger program of research to identify factors that contribute to poor adherence to PAP treatment, and how these differ between black and white patients. This will ultimately (1) enable clinical profiling of individuals with comorbid insomnia and OSA, (2) determine whether black patients diagnosed with OSA differ from their white counterparts with respect to adherence to PAP treatment, and (3) determine whether [comorbid insomnia] mediates the relationship between [race/ethnicity and poor adherence to PAP treatment] above and beyond patient and contextual factors. The proposed study will leverage the resources of the NYU and Weill Cornell Sleep Disorders Center to recruit [108] patients recently diagnosed with OSA, based on polysomnography, the gold standard for diagnosing OSA. Of these, [54 will present with comorbid insomnia and 54 without comorbid insomnia]. Polysomnography will be coupled with [a clinical interview by trained staff at the sleep clinic to classify insomnia symptoms along with the Insomnia Severity Index, and actigraphically-derived sleep data anchored by a 7-day sleep diary] and objective data for adherence to PAP treatment. The primary outcome for the study is adherence to PAP over 6 months. Training: This component of the K23 is composed of the didactic and mentored experiences required to develop the proposed program of research. The training plan builds upon my background and experience in health education with minority populations, and will provide me with the necessary training in sleep research, [epidemiology], behavioral sleep medicine, conduct of innovative health interventions, and quantitative skills. The pedagogical approach includes one-on-one mentorship, course work, mentored laboratory training, and attendance of targeted conferences and seminars, all with the common goal of supporting my transition to become an independent investigator.