Diagnosis and Treatment of Sleep Apnea in Women Veterans

睡眠呼吸障碍（SDB）与严重的不良健康后果有关，包括 心血管疾病、机动车事故、日间功能障碍和死亡风险。虽然 SDB在男性中比女性更常见，它仍然影响着总人口中17%的女性。[我们的 初步证据表明，这在接受VA护理的女性退伍军人中更为常见。的 对大多数SDB患者推荐的一线治疗是气道正压通气治疗（PAP）。 已发表的研究表明，女性的PAP依从性低于男性，特别是在美国，但我们 不知道男女退伍军人的比较数据。因为女性退伍军人经历了 睡眠障碍和睡眠障碍的其他后果，适应PAP治疗可能相当困难。 到目前为止，研究还没有测试专门设计的干预措施，以提高妇女的PAP坚持， 考虑到重要的睡眠相关和社会因素。 自2010年以来，我们一直在研究女性退伍军人的睡眠障碍，最初专注于失眠 disorder.通过这项工作，我们发现，一个显着的一部分妇女服务的VA也是高风险的 睡眠呼吸障碍（SDB;也称为睡眠呼吸暂停），特别是如果他们报告睡眠不好。在 治疗失眠，我们发现，最初的不适所造成的传统认知行为疗法， 失眠（例如最初的睡眠限制）对许多女性退伍军人来说难以忍受。我们开发并 现在正在测试一种基于接受和承诺疗法（ACT）的失眠干预措施， “接受和行为改变治疗失眠”或“ABC-I”。在ACT中，治疗侧重于 病人的价值观和实施行为改变的原因，并教导病人的策略， 为了追求与自己价值观一致的目标而忍受暂时的不适。我们现在建议使用这些 同样的治疗方法，从ACT，以解决妇女退伍军人面临的独特挑战， 适应PAP治疗 本研究是一项随机对照试验（RCT），旨在测试一个方案结合患者的疗效 使用基于ACT的技术进行教育，以提高PAP治疗的依从性，称为“ABC-SA”，或 “接受和行为改变治疗睡眠呼吸暂停。这6次会议的干预将解决最初的 不适，将治疗与患者的价值观联系起来，并纳入接受变化的方法， 治疗SDB所需的药物。将在PAP开始后3个月评估主要研究结局， 遵守情况将被远程跟踪12个月。6个疗程的“对照”干预将解释 与研究干预人员联系，并将按照常规护理进行建模。 本研究的目的是：（1）检验ABC-SA方案改善PAP的有效性 坚持，与常规护理后建模的对照计划相比，女性退伍军人SDB;（2）测试 ABC-SA计划改善客观测量和患者报告的睡眠质量的有效性， （3）检验ABC-SA方案改善生活质量的有效性 和抑郁症的症状。将使用“意向治疗”分析数据 原则，使用适当的临床试验统计方法。

Sleep disordered breathing (SDB) is associated with significant adverse health consequences including cardiovascular disease, motor vehicle accidents, daytime functional impairments and mortality risk. Although SDB is more common among men than women, it still impacts 17% of women in the general population. [Our preliminary evidence suggests it is even more common among women Veterans who receive VA care.] The recommended first-line therapy for most patients with SDB is positive airway pressure therapy (PAP). Published studies show that women have lower PAP adherence than men, particularly in the US, yet we are not aware of data comparing men and women Veterans. Because women Veterans experience significant sleep disturbance and other consequences of sleep disorders, adjusting to PAP therapy may be quite difficult. To date, studies have not tested interventions specifically designed to improve PAP adherence among women, accounting for important sleep-related and social factors. Since 2010 we have been studying sleep disorders among women Veterans, initially focusing on insomnia disorder. Through this work we discovered that a significant segment of women served by VA also are high risk for sleep disordered breathing (SDB; also referred to as sleep apnea), particularly if they report poor sleep. In treating insomnia, we found that the initial discomfort created by traditional cognitive-behavioral therapy for insomnia (e.g. initial sleep restriction) is difficult for many women Veterans to tolerate. We developed and are now testing an insomnia intervention based on Acceptance and Commitment Therapy (ACT), called “Acceptance and the Behavioral Changes to Treat Insomnia” or “ABC-I”. Within ACT, treatment focuses on a patient's values and reasons for implementing behavioral changes, and teaches the patient strategies for tolerating temporary discomfort in pursuit of goals consistent with one's values. We now propose to use these same therapeutic approach, adopted from ACT, to address unique challenges faced by women Veterans in adjusting to PAP therapy. This study is a randomized controlled trial (RCT) to test the efficacy of a program combining patient education with ACT-based techniques in improving adherence to PAP therapy, called “ABC-SA” or “Acceptance and the Behavioral Changes to treat Sleep Apnea.” This 6-session intervention will address initial discomfort, link treatment to the patient’s values and incorporate methods for accepting the changes that are required to treat SDB. Main study outcomes will be assessed 3 months after PAP initiation, and PAP adherence will be tracked remotely for 12 months. The 6-session “control” intervention will account for the contact with a study interventionist and will be modeled after usual care. The objectives of this proposal are: (1) to test the efficacy of the ABC-SA program in improving PAP adherence, compared to a control program modeled after usual care, for women Veterans with SDB; (2) to test the efficacy the ABC-SA program for improving objectively-measured and patient-reported sleep quality, compared to the control program; and (3), to test the efficacy the ABC-SA program for improving quality of life and symptoms of depression, compared to the control program. Data will be analyzed using “intention to treat” principles, using appropriate statistical methods for clinical trials.