Background: Increasing evidence from clinical studies suggests an association between obstructive sleep apnea (OSA) and insomnia, with the prevalence of this comorbidity ranging from 39% to 58%. Further, comorbid insomnia has emerged as an important clinical factor that can worsen adherence to Positive Airway Pressure (PAP) treatment, which is the first-line of treatment for patients diagnosed with OSA. Although these findings provide important insight, they are not without limitations. First, the variability n the prevalence of comorbid insomnia and OSA results from methodological limitations in assessing insomnia symptoms, including a failure to use validated tools. Second, existing studies are largely conducted in homogenous samples, making it impossible to assess racial/ethnic disparities, which is a growing concern in understanding poor adherence to PAP treatment. Research: The proposed study within this K-Award, which will be the first step in a larger program of research to identify factors that contribute to poor adherence to PAP treatment, and how these differ between black and white patients. This will ultimately (1) enable clinical profiling of individuals with comorbid insomnia and OSA, (2) determine whether black patients diagnosed with OSA differ from their white counterparts with respect to adherence to PAP treatment, and (3) determine whether [comorbid insomnia] mediates the relationship between [race/ethnicity and poor adherence to PAP treatment] above and beyond patient and contextual factors. The proposed study will leverage the resources of the NYU and Weill Cornell Sleep Disorders Center to recruit [108] patients recently diagnosed with OSA, based on polysomnography, the gold standard for diagnosing OSA. Of these, [54 will present with comorbid insomnia and 54 without comorbid insomnia]. Polysomnography will be coupled with [a clinical interview by trained staff at the sleep clinic to classify insomnia symptoms along with the Insomnia Severity Index, and actigraphically-derived sleep data anchored by a 7-day sleep diary] and objective data for adherence to PAP treatment. The primary outcome for the study is adherence to PAP over 6 months. Training: This component of the K23 is composed of the didactic and mentored experiences required to develop the proposed program of research. The training plan builds upon my background and experience in health education with minority populations, and will provide me with the necessary training in sleep research, [epidemiology], behavioral sleep medicine, conduct of innovative health interventions, and quantitative skills. The pedagogical approach includes one-on-one mentorship, course work, mentored laboratory training, and attendance of targeted conferences and seminars, all with the common goal of supporting my transition to become an independent investigator.

Public Health Relevance

The overarching objective of this K23 career development award is to foster my development into a leader in the field of behavioral sleep medicine with a unique expertise in understanding the factors that prevent or delay adherence to PAP treatment, particularly among minority patients. Data from my study will elucidate a novel mechanism underlying poor adherence to PAP treatment among patients with a diagnosis of OSA. Comorbid insomnia, as a modifiable factor, could become an important target in the development of innovative behavioral interventions to overcome barriers hindering adherence to PAP treatment, thereby enabling patients to experience the numerous benefits of PAP treatment including better sleep quality and reduced cardiovascular morbidity.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
NHLBI Mentored Patient-Oriented Research Review Committee (MPOR)
Program Officer
Stoney, Catherine
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New York University
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Robbins, Rebecca; Senathirajah, Yalini; Williams, Natasha J et al. (2018) Developing a Tailored Website for Promoting Awareness about Obstructive Sleep Apnea (OSA) Among Blacks in Community-Based Settings. Health Commun :1-9
Williams, Natasha J; Castor, Chimene; Seixas, Azizi et al. (2018) Sleep Disorders and Symptoms in Blacks with Metabolic Syndrome: The Metabolic Syndrome Outcome Study (MetSO). Ethn Dis 28:193-200
Wallace, Douglas M; Williams, Natasha J; Sawyer, Amy M et al. (2018) Adherence to positive airway pressure treatment among minority populations in the US: A scoping review. Sleep Med Rev 38:56-69
Grant, Andrea Barnes; Williams, Natasha J; Pandi-Perumal, Seithikurippu R (2017) Nonadherence to antihypertensive medications in adults with high risk for obstructive sleep apnea. J Clin Hypertens (Greenwich) 19:540-542
Jean-Louis, Girardin; Newsome, Valerie; Williams, Natasha J et al. (2017) Tailored Behavioral Intervention Among Blacks With Metabolic Syndrome and Sleep Apnea: Results of the MetSO Trial. Sleep 40:
Williams, Natasha J; Jean-Louis, Girardin; Ceïde, Mirnova E et al. (2017) Effect of Maladaptive Beliefs and Attitudes about Sleep among Community-dwelling African American Men at Risk for Obstructive Sleep Apnea. J Sleep Disord Ther 6:
Williams, Natasha J; Jean-Louis, Girardin; Ravenell, Joeseph et al. (2016) A community-oriented framework to increase screening and treatment of obstructive sleep apnea among blacks. Sleep Med 18:82-7
Williams, Natasha J; Grandner, Michael A; Wallace, Douglas M et al. (2016) Social and behavioral predictors of insufficient sleep among African Americans and Caucasians. Sleep Med 18:103-7
Williams, Natasha J; Robbins, Rebecca; Rapoport, David et al. (2016) Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial. Trials 17:585