Intensive support does not improve positive-airway pressure use in spinal cord injury/disease: a randomized clinical trial.

Autor:	Badr MS; Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.; Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA., Martin JL; Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA., Sankari A; Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.; Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA.; Department of Medical Education, Ascension Providence Hospital, Southfield, MI, USA., Zeineddine S; Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.; Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA., Salloum A; Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.; Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA., Henzel MK; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.; Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA., Strohl K; Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA., Shamim-Uzzaman A; Department of Neurology, VA Ann Arbor Healthcare System.; Department of Neurology, University of Michigan, Ann Arbor, MI, USA., May AM; Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, OH, USA., Fung CH; Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA., Pandya N; Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.; Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA., Carroll S; Department of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.; Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA., Mitchell MN; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Jazyk:	angličtina
Zdroj:	Sleep [Sleep] 2024 May 10; Vol. 47 (5).
DOI:	10.1093/sleep/zsae044
Abstrakt:	Study Objective: Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (spinal cord injury [SCI]/D). Interventions focused on increasing PAP use have not been studied in this population. We aimed to evaluate the benefits of a program to increase PAP use among Veterans with SCI/D and SDB. Methods: Randomized controlled trial comparing a behavioral Intervention (n = 32) and educational control (n = 31), both including one face-to-face and five telephone sessions over 3 months. The intervention included education about SDB and PAP, goal setting, troubleshooting, and motivational enhancement. The control arm included non-directive sleep education only. Results: Primary outcomes were objective PAP use (nights ≥4 hours used within 90 days) and sleep quality (Pittsburgh Sleep Quality Index [PSQI] at 3 months). These did not differ between intervention and control (main outcome timepoint; mean difference 3.5 [-9.0, 15.9] nights/week for PAP use; p = .578; -1.1 [-2.8, 0.6] points for PSQI; p = .219). Secondary outcomes included fatigue, depression, function, and quality of life. Only fatigue improved significantly more in the intervention versus the control group (p = .025). Across groups, more PAP use was associated with larger improvements in sleep quality, insomnia, sleepiness, fatigue, and depression at some time points. Conclusions: PAP use in Veterans with SCI/D and SDB is low, and a 3-month supportive/behavioral program did not show significant benefit compared to education alone. Overall, more PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required to increase PAP use in these patients. Clinical Trials Information: Title: "Treatment of Sleep Disordered Breathing in Patients with SCI." Registration number: NCT02830074. Website: https://clinicaltrials.gov/study/NCT02830074?cond=Sleep%20Apnea&term=badr&rank=5. (Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2024.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu