(provided by the applicant): Despite the availability of evidence-based treatment models for sleep apnea, the majority of at-risk individuals in underserved US communities remains undiagnosed. This is a major public health concern since untreated sleep apnea is linked to cardiovascular disease and components of the metabolic syndrome. Blacks endorse a disproportionate burden of sleep apnea-related morbidity. Yet, few black patients adhere to recommended sleep apnea assessment by their physician, while most referred patients receive a diagnosis of sleep apnea. Maximizing the likelihood that black patients adhere to physician recommended sleep apnea assessment and treatment, thus reducing cardio-metabolic morbidity, is the focus of this proposal.
The aims are consistent with NIH program announcement (RFA-MD-09-004), soliciting proposals to study chronic diseases that disproportionately affect underserved, and low-income ethnic minorities. In a two-arm randomized controlled trial, we will assess effectiveness of a culturally and linguistically tailored telephone intervention in increasing adherence to recommended assessment and treatment of sleep apnea. Telephone interventions will be delivered by trained, quality-controlled Health Educators. The sampling frame will consist of 340 black patients enrolled in the Metabolic Syndrome Outcome Study (MetSOS), a Brooklyn-based study of patients with cardio-metabolic diseases. Among patients with metabolic syndrome and are at high risk for sleep apnea, those randomized to the intervention arm, compared with those randomized to the attention-control arm, will have: 1) greater adherence to physician recommended sleep apnea assessment at 6 months and 2) greater adherence to treatment with Continuous Positive Airway Pressure post diagnosis;3) effects of the intervention on adherence rates will be sustained 6 months after discontinuing active interventions, and treatment will improve components of the metabolic syndrome (waist circumference, blood pressure, lipid level, and fasting plasma glucose;and 4) patients'knowledge about sleep, self-efficacy, readiness, trust/rapport with the Health Educator will mediate intervention effects on study outcomes. We expect that our intervention will serve as an alternative model of promoting awareness of sleep apnea and enhancing adherence to recommended care among blacks nationwide.
This proposal will test the effectiveness of a tailored telephone intervention in increasing adherence to recommended sleep apnea assessment and treatment among black patients at high risk for sleep apnea. The sampling frame will consist of 340 patients enrolled in the Metabolic Syndrome Outcome Study, a Brooklyn-based study of patients with cardio-metabolic diseases. We expect that our intervention will serve as an alternative model of promoting awareness of sleep apnea and enhancing adherence to recommended care among blacks nationwide.
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