Reduction in sleep health disparities was recognized as a priority area for intervention and translational research, according to the Executive Summary of the NIH workshop convened in September 2011. Obstructive sleep apnea (OSA), which disproportionately affects blacks, is an important preventable and/or treatable disease that should be targeted as it is associated with increased cardiovascular risk and disease outcomes, including obesity, diabetes, hypertension, stroke, cardiac arrhythmia, and chronic heart failure. Results of our community-based focus groups conducted among at-risk blacks suggest that most are unaware of sleep apnea symptoms or apnea-related cardiovascular morbidity. Only 26% of blacks participating in our studies adhered to recommended OSA evaluation, although 39% were at high risk for OSA. While few blacks adhered to physician's recommendations, 90% of those assessed in the laboratory received a sleep apnea diagnosis. In a two-arm cluster randomized controlled trial, we will ascertain effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at OSA risk. Blacks in the intervention arm will receive quality-controlled, culturally and linguistically tailored peer education using a sleep health education manual developed based on principles of Motivational Enhancement. They will each receive up to 4 sessions promoting OSA screening during a 6-month period. Those with a diagnosis will receive 2 additional sessions promoting OSA treatment adherence, in conjunction with telephonic interventions with an OSA Navigator contingent upon poor treatment adherence from web-based reports. Those in the attention- control arm will only receive standard OSA literature. Regardless of group assignment, we will ascertain all outcomes at baseline and at 6- and 12-month follow-up assessments. We will also assess the rate of OSA in that population using home recordings. Influence of individual-level factors (i.e., OSA knowledge, self-efficacy, readiness, and past screening behavior) and contextual-level factors (i.e., trust/rapport with Peer Educators, family network, and socioeconomic position) in mediating intervention effects on adherence status will be ascertained. The long-term goal is to apply this intervention modality in community-based settings (barbershops, beauty salons, churches, and health centers), thereby linking community health promotion to the healthcare system. Thus, our program could serve as an alternative, non-traditional model to disseminate this intervention for cardiovascular risk reduction in blacks nationwide. The potential for dissemination is high, as there are over 18-thousand black barbershops and 13-thousand black churches in urban centers across the United States.
This collaborative research project will build capacity to support evaluation and referral of black men and women at risk for sleep apnea at the community level. It will examine whether a culturally and linguistically tailored peer-based sleep health intervention will increase adherence to recommended sleep apnea screening and treatment among blacks in barbershops, beauty salons and churches. Three hundred and ninety eight blacks will be enrolled in the study and will be followed for a year to evaluate intervention response.
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