Engaging African American Couples in the Management of Obstructive Sleep Apnea

ABSTRACT Obstructive sleep apnea (OSA) affects 26% of adults over age 30 and is associated with significant morbidity and mortality. At the time of presentation, African American have more severe OSA and have more associated complications compared to other groups. Continuous positive airway pressure (CPAP)

is an effective treatment for OSA that improves sleepiness and quality of life in a dose response fashion. Therefore, it is recommended that patients use it whenever they sleep. However, CPAP use among African Americans is low. Many patients with OSA visit a health care provider at the urging of their bed

partners who themselves may be experiencing decreased sleep and quality of life due to their partners’ OSA. We reasoned that bed partners may positively effect CPAP adherence. We conducted interviews of African American patients with OSA and their bed partners. They recommended a couple-oriented intervention to increase CPAP adherence. With their help we developed a couple-oriented behavioral

therapy intervention. We now propose a full scale randomized controlled trial involving 220 African American patients with OSA of 2 large, urban healthcare systems and their bed partners. Patients randomized to the usual care arm will receive a CPAP machine and supplies with standardized OSA and CPAP education from a

certified sleep technician. Patients and bed partners in the intervention arm will also receive a CPAP machine and supplies with standardized education regarding OSA and CPAP from a certified sleep technician. In addition, patients and partners will receive tailored text messages encouraging CPAP adherence. The couples will receive five 1-hour virtual cognitive behavioral couple therapy sessions with

a behavioral sleep psychologist. Primary analyses will compare CPAP adherence at 1-year. Secondary analyses will compare CPAP adherence at 1, 3, and 6 months. We will also measure the duration and quality of sleep, functional status, and quality of life of patients and their bed partners. Novel features of the proposed project include a rigorous randomized controlled trial design, short- and

long-term follow-up, and remotely monitoring of daily CPAP adherence data directly from the machines. The project has the potential not only to improve patient sleep and well-being but also to improve the sleep and well-being of their bed partners. Furthermore, it may serve as a model for future trials of

couple-oriented therapy among patients with other sleep disorders.