Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Pilot Study of CPAP Adherence Promotion by Peer Buddies With Sleep Apnea
Brief Summary: 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.


Options:
A: Inclusion Criteria:

1. Men and women ≥ 65 years old.
2. Patients diagnosed with OSA with an apnea-hypopnea index per hour \>30.
3. Patients with an Epworth Sleep Scale score ≤ 12 (without excessive daytime sleepiness).
4. Signed written informed consent.

Exclusion Criteria:

1. Patients with severe chronic diseases: cardiovascular or pulmonary, neurological (stroke, epilepsy, head injury...) or psychiatric.
2. Any current significant systemic illness or unstable medical condition that could lead to difficulty in complying with the protocol or may, in the opinion of the investigator, compromise the conclusions.
3. Mini Mental State Exam (MMSE) \<24.
4. Any MRI exclusions - presence of aneurysm clips, pacemakers, mechanic heart valves, ear implants, metal fragments or foreign objects in the eyes, skin or body.
5. Previous CPAP treatment.
6. Psycho-physical inability to complete questionnaires. Inadequate visual and auditory acuity will be excluded.
7. Presence of any previously diagnosed sleep disorders: narcolepsy, insomnia, chronic sleep deprivation, REM behavior disorder and restless leg syndrome.
8. Patients with \> 50% of central apneas or the presence of Cheyne-Stokes Respiration.
9. History of alcohol abuse or dependence.
B: Inclusion Criteria:

1. Obstructive Sleep Apnea (defined by Apnea-hypopnea index \[AHI\] \> 5 per hour; with hypopneas defined as greater than 30% reduction in airflow with 4 or greater drop in oxygen saturation). AHI will be determined by full night or split-night polysomnography.
2. Age range 21 - 85 years old.
3. Stable medical history and no change in medications, including anti-hypertensive and thyroid replacement, in the previous 4 months.
4. No regular use (\> 3 times/week) of sedative or hypnotic medications in the last 4 months.

Exclusion Criteria:

1. Central sleep apnea (central apnea index \> 5 per hour and \>50% of Apnea-hypopnea index constituted by central apneas and non-obstructive hypopneas).
2. Complex sleep apnea or CPAP emergent central apnea (Central apnea index \> 5 per hour during CPAP titration with \>50% of Apnea-hypopnea index constituted by central apneas and non-obstructive hypopneas).
3. Requiring oxygen or bi-level positive airway pressure for treatment of OSA or hypoventilation.
4. Decompensated cardiac (heart failure or angina) or pulmonary (severe COPD or uncontrolled asthma) disease
5. Chronic narcotic use
6. Nasal obstruction (nasal congestion score \> 15) or enlarged tonsils
7. Diagnosis of another sleep disorder in addition to OSA based on PSG (e.g., periodic limb movement disorder \[ 15 limb movements/hour of sleep with arousal\], central sleep apnea \[ 50% of apneas on diagnostic PSG are central apneas\], insomnia, obesity hypoventilation syndrome, or narcolepsy).
8. Previous treatment with positive airway pressure, home oxygen therapy, tracheotomy, uvulopalatopharyngoplasty, or other surgery for OSA.
9. Night shift workers in situations or occupations where they regularly experience jet lag, or have irregular work schedules by history over the last 6 months.
10. Routine consumption of more than 2 alcoholic beverages per day.
11. Recent or recurring history of recreational drug use leading to tolerance or dependence.
12. Unable to perform tests due to inability to communicate verbally, inability to write and read in English; less than a 5th grade reading level; visual, hearing or cognitive impairment (e.g. previous head injury); or upper extremity motor deficit (e.g., previous stroke that prevents patient from using CPAP treatment).
C: Inclusion Criteria:

* newly diagnosed obstructive sleep apnea syndrome by polysomnography according to standard criteria,
* with moderate to severe sleep apnea,
* no history of previously CPAP therapy and
* with an above-elementary school education.

Exclusion Criteria:

* refusal to participate,
* refusal to CPAP therapy,
* previous CPAP treatment,
* central sleep apnoea syndrome,
* Cheyne-stokes breathing pattern,
* obesity hypoventilation syndrome,
* restrictive ventilator syndromes,
* congestive heart failure,
* history of life-threatening arrhythmias,
* cardiomyopathy,
* long term oxygen therapy,
* family or personal history of mental illness,
* with drug or alcohol abuse,
* severe cognitive impairment,
* concurrent oncologic diseases and
* history of narcolepsy.
D: Inclusion Criteria:

* Patients aged \> 18 years of age who are referred to the University of Chicago sleep laboratory for split-night polysomnography by a non-sleep physician and who have a consultation appointment with a sleep physician following the appointment
* Have not had prior contact with a sleep physician or prior exposure to CPAP therapy.

Exclusion Criteria: Subjects will be excluded for any of the following characteristics: -Non-English speaking

* Illiterate
* Sleep study is negative for sleep apnea (apnea-hypopnea index \< 5 events/hr)
* Subject does not undergo CPAP titration during the in-laboratory polysomnogram
* Subject does not have a working telephone number
* Poor eyesight or hearing
* Dementia

Answer: B