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. 2022 Nov;67(4):461-473.
doi: 10.1037/rep0000473.

Improving sleep apnea treatment adherence after traumatic brain injury: A nonrandomized feasibility study

Marc A Silva  1 , Nora B Arriola  2 , Chad K Radwan  2 , Brent M Womble  3 , Erica A Healey  1 , Jaylene M Lee  1 , Mark S Aloia  4 , Risa Nakase-Richardson  1
Affiliations

Improving sleep apnea treatment adherence after traumatic brain injury: A nonrandomized feasibility study

Marc A Silva et al. Rehabil Psychol. 2022 Nov.

Abstract

Purpose/objective: To evaluate the feasibility of a psychological intervention designed to increase Positive Airway Pressure (PAP) adherence, adapted with cognitive accommodations for comorbid obstructive sleep apnea (OSA) and traumatic brain injury (TBI).

Research method/design: This was an open-label single arm (nonrandomized) study. Eligibility criteria were moderate-to-severe TBI, OSA diagnosis, prescribed PAP, nonadherent, and able to consent. Participants were recruited from inpatient and outpatient settings at a tertiary care hospital. The four-module manualized intervention was delivered primarily via telehealth. Feasibility aspects measured included eligibility, recruitment, and retention rates; session duration and attendance; and characteristics of outcome and process measures (e.g., completion rates, data distribution). Symptom measures included the Epworth Sleepiness Scale, Fatigue Severity Scale, Functional Outcomes of Sleep Questionnaire, Self-Efficacy Measure for Sleep Apnea, OSA Treatment Barriers Questionnaire (OTBQ), and Kim Alliance Scale-Revised.

Results: Of 230 persons screened, 14.3% were eligible. Recruitment rate (n = 17) was 51.5%. Retention rate (n = 13) was 76.5%. Treatment completers had no missing data. The OTBQ deviated from normality, but other measures had adequate skew (< 2.0) and kurtosis (< 7.0) and were free from significant floor and ceiling effects (<15%). Change score effect sizes were minimal to moderate (d = .10-.77). There were no adverse events.

Conclusions/implications: These results inform ways in which procedures should be modified to enhance the success of a future clinical trial testing the efficacy of this adherence intervention. Inclusion criteria should be reconsidered, and recruitment sites expanded, to capture eligible persons and adequately power an efficacy study. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT04221009.

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Conflict of interest statement

Dr. Aloia was employed by Philips, Inc during this study and is a company stockholder. The authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
Health Belief Model applied to Positive Airway Pressure (PAP) adherence. ESS = Epworth Sleepiness Scale; FOSQ = Functional Outcome of Sleep Questionnaire; FSS = Fatigue Severity Scale; OTBQ = OSA Treatment Barriers Questionnaire; SEMSA = Self Efficacy Measure for Sleep Apnea; SEMSA-R = Self Efficacy Measure for Sleep Apnea-Risk Perception; SEMSA-SE = Self Efficacy Measure for Sleep Apnea-Treatment Self Efficacy; SEMSA-TE = Self Efficacy Measure for Sleep Apnea-Treatment Expectancies.
Figure 2
Figure 2
Flow diagram. OSA = Obstructive Sleep Apnea; TBI = Traumatic Brain Injury.
Figure 3
Figure 3
Figure 3A (top) depicts self-reported hours of Positive Airway Pressure (PAP) use per night. Figure 3B (bottom) depicts self-reported nights of Positive Airway Pressure (PAP) use per week.
See this image and copyright information in PMC

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