This proposal aims to test the efficacy of a comprehensive approach to improving positive airway pressure (PAP) therapy acceptance and adherence and sleep quality among patients with SCI/D. The proposed study is very relevant to the mission of the VA in promoting optimal health for all Veterans, including those with disabilities. To this end, this study is a randomized controlled trial (RCT) testing the efficacy of a combined sleep and PAP adherence program, called the ?BEST? program (Best practices PAP + patient Education + ongoing Support and Training), compared to a control program including non-directive sleep education plus standard treatment of SDB. The central aim of this proposal therefore is to test the efficacy of the BEST program in improving a number of patient outcomes, compared to a control program (sleep education plus standard care for SDB). The study has two main aims. First, we aim to test the efficacy of the BEST program in improving adherence to PAP therapy for the first 6 months of use (with data available for some subjects for up to 12 months). Second, we will evaluate the impact of the program on sleep quality and on three key areas of function: general functioning (using measures specific to SCI/D patients), respiratory functioning (via spirometry) and quality of life (assessed with measures appropriate for use with patients having limited mobility) over the 3-month intervention period. We hypothesize that the BEST program will result in higher rates of adherence to PAP, better sleep quality, and better functioning in all three assessed domains (general, respiratory and quality of life). We will also explore whether the intervention is more effective for some subgroups of patients than others. The proposed work is very relevant to VA's patient care mission, addressing a critical need for patients who suffer from disparity in access to high quality care because of their disabilities. We anticipate that our work will yield significant new knowledge that improves the health and quality of life for Veterans living with SCI/D.

Public Health Relevance

Sleep-disordered breathing (SDB) remains under-treated in individuals living with spinal cord injuries and disorders (SCI/D). Our aim is to test a program that addresses challenges and barriers to positive airway pressure (PAP) treatment of SDB among patients with SCI/D. We anticipate that patients who receive this program will have higher rates of PAP use and will demonstrate improvements in sleep quality, general functioning, respiratory functioning and quality of life from baseline to 6 months follow up compared to individuals who receive a control program. This work addresses critical healthcare needs for patients with SCI/D and may lead to improved health and quality of life for these patients.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Spinal Cord Injury/Disorders & Neuropathic Pain (RRDA)
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John D Dingell VA Medical Center
United States
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Sankari, Abdulghani; Martin, Jennifer L; Badr, M Safwan (2017) Sleep Disordered Breathing and Spinal Cord Injury: Challenges and Opportunities. Curr Sleep Med Rep 3:272-278