A Pilot Study of CPAP Adherence Promotion by Peer Buddies With Sleep Apnea
| Status: | Archived |
|---|---|
| Conditions: | Insomnia Sleep Studies, Pulmonary |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 7/1/2011 |
| Start Date: | July 2010 |
| End Date: | June 2012 |
Obstructive sleep apnea (OSA) is a highly prevalent condition in veterans with some
estimates as high as 47%. Poor adherence to the primary treatment of OSA -- continuous
positive airway pressure (CPAP) therapy - is associated with increased risk for heart
attacks, strokes and even death. The investigators plan to improve CPAP adherence in
veterans through their interactions with peers who have successfully adopted CPAP therapy.
Such "peer-buddies" may promote the well-being of veterans while remaining highly
cost-effective when compared to healthcare providers. Our strategy is grounded on the
rationale that veterans as a group are ecoculturally more homogenous than expected for the
given level of differences in age, gender, ethnicity, or socioeconomic strata. Our long-term
objectives are to initiate a larger, multi-site, research study for enhancing CPAP adherence
in veterans with OSA. The ultimate goal of this research is to develop a cheap, effective
and exportable system of care to promote CPAP adherence in patients with OSA.
Project background: Obstructive sleep apnea (OSA) is a prevalent condition that is most
frequently treated with continuous positive airway pressure (CPAP) therapy. Non-adherence to
such therapy, however, afflicts a high proportion of adults with sleep apnea (46-83%).
Moreover, such non-adherence to CPAP is associated with increased risk for fatal and
non-fatal cardiovascular events. There remains a paucity of reliable and cost-effective
interventions that could promote CPAP adherence. Promoting adherence to therapy through
peer-driven intervention is cheap and has met with modest success in other chronic
conditions such as HIV, heart failure and diabetes mellitus. Whether such a peer-driven
("buddy") system can improve adherence to CPAP therapy is unknown.
Project Objectives: Our overall aim is to assess the feasibility and acceptability of a CPAP
adherence program driven by trained "peer-buddies" with sleep apnea. Specific Objective #1:
To evaluate patient ratings of the acceptability of the peer buddy system (PBS) in veterans
receiving CPAP therapy for OSA. Specific Objective #2: To obtain preliminary data on the
effectiveness of PBS on sleep-specific HR-QOL (Functional outcomes in sleep questionnaire
[FOSQ]) in veterans receiving CPAP therapy for OSA. Specific Objective #3: To obtain
preliminary data on the effect of PBS on CPAP adherence, vigilance, patient activation, and
self-efficacy in veterans receiving CPAP therapy for OSA.
Project Methods: In order to address these aims, we will recruit recently diagnosed patients
with OSA who have not been initiated on CPAP therapy and randomly assign them to the
peer-buddy system to promote adherence to CPAP therapy (intervention group) or be assigned
to usual care (control group). In the PBS intervention group, trained peers with sleep apnea
will be paired with the newly diagnosed patients over a 3- month period. During this time
the trained peers will share experiences on coping strategies with CPAP device and equipment
(promote self efficacy), share their positive experiences (motivational effects and outcome
expectancies), share their knowledge of perceived vulnerabilities due to untreated sleep
apnea (promote risk perception), share methods for improving efficacy of CPAP equipment and
interface (patient education) and prepare their subjects for upcoming physician or
respiratory therapist appointments (patient activation). The interaction will occur during
supervised "in-person" sessions and during telephonic conversations over the 3-month period.
Subjects from both groups will be reassessed at the end of 3 months in order to determine
objective measures of CPAP adherence, sleep-specific HRQOL Functional outcomes of sleep
questionnaire [FOSQ]), vigilance (psychomotor vigilance testing), measures of self-efficacy
(outcome expectancy, treatment self-efficacy, and risk perception [SEMSA questionnaire]) and
patient activation (Patient Activation Measure [PAM]).
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