Tailored Treatment to Enhance Risk Perception in Sleep Apnea

National Jewish Health, Denver CO

Investigators

Abstract

DESCRIPTION (provided by applicant): Obstructive Sleep Apnea (OSA) is seen in approximately 6% of Americans. It is a serious medical condition with significant medical and psychological consequences. Studies have demonstrated a greater utilization of the healthcare system in patients untreated for OSA. The treatment of choice for OSA is Positive Airway Pressure therapy (PAP). PAP supplies positive pressure to the upper airway creating a pneumatic splint to keep the airway open during sleep. Adherence to PAP is notoriously low, with as few as 50% reaching minimal guidelines for adherence. The problem of adherence is significant because of the medical consequences that can ensue and because third party payers have begun to refuse to pay for PAP therapy when adherence is less than optimal. We have examined over 500 patients through the first year of PAP therapy and found that one reason for poor adherence is that patients do not perceive a real threat from their illness (low risk perception). There may be several reasons for low risk perception among patients with OSA. Patients often do not experience the symptoms of their disorder. The primary signs of OSA occur during sleep and go unnoticed by most patients. Patients often seek treatment at the impetus their significant others who directly observe their apnea. We believe that an intervention designed to augment risk perception will help improve adherence rates. Our pilot data support the use of a brief risk augmentation intervention. We conducted a pilot in which patients observed themselves having apneas via video recording. These recordings are routinely obtained as a part of clinical sleep studies. Patients watched themselves struggle to breathe and saw the associated drop in blood oxygen levels (see example video at https://www.nationaljewish.org/deleted/nih-study/; username: markaloia12!; password markaloia123!). Patients also saw a second video of themselves sleeping while using PAP. Their personalized improvement in oxygen saturation was noted as well as the potential short and long- term benefits of treating their sleep apnea. We compared this intervention with an active control group who received a non-personalized educational video. The personalized video resulted in the best, long-term improvement in adherence to PAP seen in the literature to date (a 2 hour/night increase over the control group over 3 months). We believe that a brief personalized video (BPV) will improve long-term adherence and increase risk perception among newly diagnosed patients with OSA compared to both a non- personalized video (NPV) and treatment as usual (TAU). Specifically, we hypothesize that a BPV will increase adherence to PAP, positive outcomes associated with PAP treatment and risk perception associated with OSA. Outcome measures will include psychological functioning, cognitive functioning, and sleep-related outcomes. We propose to recruit 300 participants into one of the three groups to assess the benefits of our brief personalized video and follow them for their first full year of PA therapy to test our hypotheses. This proposal addresses a serious public health issue of poor adherence to treatment, which could have profound effects on patient outcomes and healthcare utilization.