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

 描述（由申请人提供）：背景：越来越多的临床研究证据表明阻塞性睡眠呼吸暂停（OSA）和失眠之间存在关联，这种合并症的患病率为39%至58%。此外，共病失眠已经成为一个重要的临床因素，可以恶化坚持气道正压通气（PAP）治疗，这是一线治疗诊断为OSA的患者。虽然这些发现提供了重要的见解，但它们并非没有局限性。首先，失眠和OSA共病患病率的变异性来自于评估失眠症状的方法学限制，包括未能使用有效的工具。其次，现有的研究主要是在同质样本中进行的，因此无法评估种族/民族差异，这是了解PAP治疗依从性差的一个日益关注的问题。调研：这项K奖中的拟议研究将是一个更大的研究项目的第一步，该项目旨在确定导致PAP治疗依从性差的因素，以及这些因素在黑人和白色患者之间的差异。这将最终（1）实现患有失眠和OSA共病的个体的临床特征分析，（2）确定诊断患有OSA的黑人患者是否与他们的白色对应者在坚持PAP治疗方面不同，以及（3）确定[共病失眠]是否介导[种族/民族和对PAP治疗的不良坚持]之间的关系，而不仅仅是患者和背景因素。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，招募[108]最近诊断为OSA的患者，基于多导睡眠图，诊断OSA的金标准。其中，[54例将出现共病失眠，54例无共病失眠]。多导睡眠图将与睡眠诊所训练有素的工作人员进行的临床访谈相结合，对失眠症状进行沿着 失眠严重程度指数，以及由7天睡眠日记锚定的活动记录法得出的睡眠数据]和PAP治疗依从性的客观数据。该研究的主要结果是坚持PAP超过6个月。培训：K23的这一组成部分由开发拟议研究计划所需的教学和指导经验组成。该培训计划建立在我的背景和经验，在健康教育与少数民族人口，并将为我提供必要的培训，在睡眠研究，[流行病学]，行为睡眠医学，进行创新的健康干预，和定量技能。教学方法包括一对一的指导，课程工作，指导实验室培训，以及参加有针对性的会议和研讨会，所有这些都是为了支持我成为独立调查员的过渡。

 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.