An estimated 70 million people in the United States suffer from sleep problems, and more than half of them have a sleep disorder that is chronic. Sleep problems and disorders have major societal impacts including drowsy driving accidents and deaths, lost productivity, and high costs. One of the key research recommendations put forth by both the 2003 National Sleep Disorders Research Plan and a recent NIH workshop is a better understanding of sleep disorders treatments, including adherence to those treatments, in order to inform evidence-based guidelines for the improved management of sleep disorders. The most prevalent class of sleep disorders are Sleep-Related Breathing Disorders (SRBD), and in particular, obstructive sleep apnea (OSA). SRBD treatment regimens include medical devices, oral appliances, and behavioral recommendations. Nonadherence (noncompliance) occurs when individuals do not successfully carry out the health behavior recommendations made by their health professionals, and is a widespread behavioral problem that results in wasted health care visits, expensive and dangerous medical complications, failures of treatment, and missed opportunities to improve and maintain quality of life. The databases of the National Library of Medicine contain scientific journal articles published from all over the world on SRBD treatment adherence yet there exists little empirically based consensus regarding how best to solve this serious, largely behavioral problem. This project will systematically search the PubMed database (supplemented by PsyInfo and the Cochrane Central Register of Controlled Trials) and use the techniques of meta-analysis to organize, quantitatively summarize, and statistically integrate the results of all published empirical research analyzing all correlates, determinants, and consequences of patient adherence (compliance) to interventions for SRBD that are given by healthcare providers. An organized, empirically-based framework of explanatory factors that capture the broad range of influences on patient adherence to many varying aspects of SRBD management will be used. Calculation of multiple, conceptually driven meta-analyses will entail the collection and statistical combination of effect sizes, and will contribute to the building of straightforward data-driven models to achieve a detailed understanding of patient adherence as a mediator of health outcomes. The goal of the project is to identify necessary future research strategies and factors with the greatest potential for behavioral intervention to increase adherence and improve health outcomes for SRBD patients.
