Obstructive Sleep Apnea (OSA) is seen in approximately 6% of Americans. It is a serious medical condition with significant medical and psychological consequences. Studies have demonstrated a greater utilization of the healthcare system in patients untreated for OSA. The treatment of choice for OSA is Positive Airway Pressure therapy (PAP). PAP supplies positive pressure to the upper airway creating a pneumatic splint to keep the airway open during sleep. Adherence to PAP is notoriously low, with as few as 50% reaching minimal guidelines for adherence. The problem of adherence is significant because of the medical consequences that can ensue and because third party payers have begun to refuse to pay for PAP therapy when adherence is less than optimal. We have examined over 500 patients through the first year of PAP therapy and found that one reason for poor adherence is that patients do not perceive a real threat from their illness (low risk perception). There may be several reasons for low risk perception among patients with OSA. Patients often do not experience the symptoms of their disorder. The primary signs of OSA occur during sleep and go unnoticed by most patients. Patients often seek treatment at the impetus their significant others who directly observe their apnea. We believe that an intervention designed to augment risk perception will help improve adherence rates. Our pilot data support the use of a brief risk augmentation intervention. We conducted a pilot in which patients observed themselves having apneas via video recording. These recordings are routinely obtained as a part of clinical sleep studies. Patients watched themselves struggle to breathe and saw the associated drop in blood oxygen levels (see example video at www.nationaljewish.org/deleted/nih-study/; username: markaloia12!; password markaloia123!). Patients also saw a second video of themselves sleeping while using PAP. Their personalized improvement in oxygen saturation was noted as well as the potential short and long- term benefits of treating their sleep apnea. We compared this intervention with an active control group who received a non-personalized educational video. The personalized video resulted in the best, long-term improvement in adherence to PAP seen in the literature to date (a 2 hour/night increase over the control group over 3 months). We believe that a brief personalized video (BPV) will improve long-term adherence and increase risk perception among newly diagnosed patients with OSA compared to both a non- personalized video (NPV) and treatment as usual (TAU). Specifically, we hypothesize that a BPV will increase adherence to PAP, positive outcomes associated with PAP treatment and risk perception associated with OSA. Outcome measures will include psychological functioning, cognitive functioning, and sleep-related outcomes. We propose to recruit 300 participants into one of the three groups to assess the benefits of our brief personalized video and follow them for their first full year of PA therapy to test our hypotheses. This proposal addresses a serious public health issue of poor adherence to treatment, which could have profound effects on patient outcomes and healthcare utilization.

Public Health Relevance

Obstructive Sleep Apnea (OSA) is a medical disorder with medical and psychological consequences. The disorder affects approximately 6% of Americans. OSA occurs when the throat closes during sleep, cutting off the airway and causing the patient to stop breathing and, often, to lose oxygen to their vital organs. The treatment for OSA is Positive Airway Pressure therapy (PAP), which blows air into the nose and mouth creating a mechanism to keep the airway open during sleep. Given the seriousness of the disorder, one would think that patients who are diagnosed with OSA would use PAP therapy regularly. In fact, adherence to PAP therapy is as poor as adherence to almost any medical treatment. After working with many patients in our PAP therapy adherence research, we believe that a critical piece to poor PAP adherence is that patients experience OSA while they are asleep and never see the seriousness of their own breathing disorder. This results in a poor perception of the risks of the disorder. Our goal in this proposal is to enhance risk perception by showing patients a video of themselves having a breathing problem during sleep. This video is obtained as a normal part of the patient's sleep study and we have condensed the video to allow patients to see themselves struggling and also to see the benefits of PAP therapy. We demonstrated, through a brief pilot trial, that patients who see themselves having breathing problems during sleep take their disorder very seriously and subsequently use PAP therapy much more than patients who simply see an educational PAP video. This risk perception intervention could have profound effects on the lives of these patients and could easily be incorporated into the clinical care of patients as the videos already exist and the intervention only takes 30 minutes to deliver. We propose a test of the personalized video against a non-personalized video and treatment as usual. We hypothesize that the brief personalized video will improve adherence and outcomes associated with apnea as well as enhancing the perception of risk.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Brown, Marishka
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National Jewish Health
Independent Hospitals
United States
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