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

项目摘要/摘要： 中风的负担仍然高得令人无法接受，而且很少有治疗方法被证明可以改善中风的预防 或者康复。据估计，70%到90%的中风幸存者患有阻塞性睡眠呼吸暂停(OSA)。与.相比 无阻塞性睡眠呼吸暂停的卒中患者在住院康复后的功能结果较差 (IPR)，IPR停留时间延长40%，非致命性心血管事件的风险增加100%，尤其是 中风复发，早逝风险增加75%。观察数据表明，使用 持续气道正压(CPAP)是阻塞性睡眠呼吸暂停综合征的一线治疗方法，有望改善中风 结果，包括预防复发和改善康复。然而，CPAP遵守不力已经 对患有阻塞性睡眠呼吸暂停综合征的中风幸存者的试点试验结果喜忧参半，限制了测试能力 CPAP疗效。改善CPAP依从性的个性化行为干预在以下方面显示出好处 普通人群，尽管对其在中风患者中优化CPAP的有效性知之甚少， 他们可能会对行为干预做出不同的反应。我们建议对中风进行调整和完善 对患者进行多因素行为干预以提高CPAP的依从性和参与度 中风幸存者。然后，在一项多中心随机对照试验中，我们将测试 在住院康复期间启动的干预措施，对卒中患者在3个疗程中使用CPAP 月份。遵守干预将包括：1)CPAP技术支持，2)激励增强 治疗，以及3)使用具有自动支持的移动卫生技术的自我监测。如果成功，则 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的全部好处。它是 很难想象有一种非侵入性的、相对低成本的干预措施，具有与CPAP类似的潜力 中风是一种常见的致残性疾病。

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.