A Pilot Study of CPAP Adherence Promotion by Peer Buddies With Sleep Apnea
Condition: Sleep Apnea
MeSH terms: Apnea; Sleep Apnea Syndromes
Study type: Interventional

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.
    

Detailed description: 
      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]).
    

Intervention name(s): Peer-driven intervention; Usual Care
Intervention type(s): Behavioral; Other
Intervention description(s): 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).; All participants will receive usual care following initiation of CPAP therapy. Visits with respiratory therapist and sleep physician wherein patients are educated about the basics of the care and operation of the device, mask and related equipment. Subsequently, their CPAP adherence is monitored and appropriate interventions such as mask change and re-education undertaken as needed.
Other intervention name(s): Peer-buddy system (PBS)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: sleep apnea; adherence