This is an application for a VA Rehabilitation Research and Development (RR&D) Merit Review Award submitted by Lisa M. Kinoshita, Ph.D. Dr. Kinoshita is currently a Staff Clinical Psychologist at the VA Palo Alto Health Care System with a current 6/8ths VA appointment. Dr. Kinoshita is an established clinician- scientist who conducts patient-centered clinical research on PTSD, obstructive sleep apnea (OSA) and cognition. This award will provide Dr. Kinoshita and her research team with the resources necessary to develop a novel cognitive-behavioral therapy intervention for PTSD Veterans with OSA (CBT-OSA) to increase adherence to continuous positive airway pressure (CPAP) treatment, the standard of care for OSA treatment. To accomplish this goal, she has gathered a team that includes seven Co-Investigators: Dr. Jerome Yesavage (a geriatric psychiatrist and renowned expert in cognitive and psychiatric functioning across the lifespan); Dr. Ware Kuschner (a Board Certified Sleep Medicine physician and a specialist in sleep and sleep disordered breathing); Dr. Jon-Erik Holty (a Board Certified Sleep Medicine physician and a specialist in the diagnosis and treatment of OSA); Dr. Clete Kushida (a Board Certified Sleep Medicine physician and an expert in clinical trials related to sleep disorders and a specialist in the diagnosis and treatment of sleep disorders); Dr. Jauhtai Cheng (a Board Certified Sleep Medicine physician and an expert in the diagnosis of OSA); Dr. Joy Taylor (a cognitive psychologist and expert in the trajectory of cognitive decline); and Dr. Leah Friedman (an expert in sleep and aging and CBT interventions for insomnia and memory); and a team of consultants: Dr. Kristine Yaffe (an internationally renowned expert in sleep disorders, PTSD, aging, cognition and epidemiology); Dr. Craig Rosen (a Clinical Psychologist with an expertise in PTSD diagnosis and treatment, including evidence- based practices); Dr. Donn Posner (a Clinical Psychologist with an expertise in CBT for insomnia and other sleep disorders); Dr. Laura Lazzeroni (a biostatistician with expertise in design/analysis of clinical trials, longitudinal data analysis, and missing data analysis); and Art Noda (a data analyst and database manager with extensive background using Statistical Analysis System (SAS) software, database construction and complex statistical analysis). The purpose of this proposal is to test a novel cognitive-behavioral therapy (CBT) intervention to increase CPAP treatment adherence for PTSD Veterans with a new diagnosis of OSA. [A total of 120 Veterans with PTSD and OSA will be randomized to CBT-OSA or to the RT-only arm.] Intervention effects will be examined at time points during and post-intervention throughout the 1-year study. The Primary Aim of this study is to examine the efficacy of CBT-OSA in increasing the average hours per night of CPAP use. Dr. Kinoshita will also use advanced statistical techniques to evaluate the impact of the CBT-OSA intervention on: daily functioning, mood and quality of life (Specific Aim 2); cognition (Specific Aim 3); and PTSD symptoms (Specific Aim 4) in Veterans with PTSD. This award will create an ideal environment where Dr. Kinoshita and her research team can establish the necessary efficacy data for this novel CBT-OSA treatment. If the intervention is successful, the CBT-OSA treatment may be disseminated to providers within VHA through VA's Evidence-Based Practices (EBP) national roll-out program.
Approximately 20 million Americans suffer from Obstructive Sleep Apnea (OSA) creating risks for major health problems, including dementia, heart attack, and stroke. Obesity, a growing problem for Americans and Veterans alike, is the greatest risk factor for the development of OSA. Male gender and smoking, other OSA risk factors, are common in Veterans. Given the high comorbidity of these risk factors in Veterans, OSA presents a significant health burden to Veterans. Our prior work provides evidence that OSA occurs in up to 69% of Vietnam-era Veterans with PTSD. OSA is easily treated; however, 15-30% of OSA patients are non- compliant with continuous positive airway pressure (CPAP), the standard OSA treatment. The proposed research aims to facilitate adherence to CPAP treatment by testing a novel cognitive-behavioral therapy intervention in Veterans with PTSD. If successful, it may represent an approach that could be applied to the rehabilitation of other chronic conditions with similar barriers to care.
