The impact of cannabis use proximal to sleep and cannabinoid metabolites on sleep architecture.

Study Objectives: Cannabis is a common sleep aid; however, the effects of its use prior to sleep are poorly understood. This study aims to determine the impact of nonmedical whole plant cannabis use 3 hours prior to sleep and measured cannabis metabolites on polysomnogram measures.

Methods: This is a cross-sectional study of 177 healthy adults who provided detailed cannabis use history, underwent a 1-night home sleep test and had measurement of 11 plasma and urinary cannabinoids, quantified using mass spectroscopy, the morning after the home sleep test.

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

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.

Impact of an Extended Telemonitoring and Coaching Program on Continuous Positive Airway Pressure Adherence.

The benefits of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea are limited by adherence. Telemonitoring and coaching have been demonstrated to increase adherence, but the ideal duration of such support is unclear. To compare the impact of a 12-month versus a 3-month behavioral support program on CPAP adherence.

A latent-class heteroskedastic hurdle trajectory model: patterns of adherence in obstructive sleep apnea patients on CPAP therapy.

Background: Sleep apnea patients on CPAP therapy exhibit differences in how they adhere to the therapy. Previous studies have demonstrated the benefit of describing adherence in terms of discernible longitudinal patterns. However, these analyses have been done on a limited number of patients, and did not properly represent the temporal characteristics and heterogeneity of adherence.

Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence.

Limited data suggest racial disparities in continuous positive airway pressure (CPAP) adherence exist. To assess whether CPAP adherence varies by neighborhood racial composition at a national scale. Telemonitoring data from a CPAP manufacturer database were used to assess adherence in adult patients initiating CPAP therapy between November 2015 and October 2018.

Obstructive sleep apnea and early weight loss among adolescents undergoing bariatric surgery.

Background: Little is known regarding obstructive sleep apnea's (OSA's) prevalence or the factors related to OSA remission post-metabolic bariatric surgery (MBS) in adolescents.

Objectives: To identify the baseline OSA prevalence in adolescents with severe obesity and examine factors associated with post-MBS OSA remission.

Setting: Tertiary-care children's hospital.

Age and Sex Disparities in Adherence to CPAP.

Background: CPAP effectiveness is limited by suboptimal adherence. Prior studies of adherence have focused on middle-aged men.

Research Question: Does CPAP adherence vary by age and sex?

Study Design And Methods: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in patients initiating CPAP therapy between November 2015 and October 2018.

Adherence to CPAP: What Should We Be Aiming For, and How Can We Get There?

The purpose of this review was to summarize what is currently known regarding two important questions facing the field of sleep medicine today: (1) How many hours of CPAP use per night are necessary to improve daytime symptoms and reduce cardiovascular risk associated with OSA?; and (2) What strategies could be implemented to optimize adherence in clinical settings? Despite the widespread adoption of a threshold approach to CPAP management, the literature to date suggests a dose-response relationship between CPAP usage and a range of outcomes, including sleepiness, functional status, and BP; the data also suggest that the optimal adherence level differs depending on the outcome in question. Over the years, psychological measures of behavior change constructs have been increasingly recognized as the most consistent predictors of CPAP adherence, and, as such, the most successful interventions for optimizing adherence have been behavioral in nature. Unfortunately, behavioral therapies have not been translated from highly controlled research settings to comparative-effectiveness studies and finally into routine care, mainly due to feasibility and cost issues.

A Couples-Oriented Intervention for Positive Airway Pressure Therapy Adherence: A Pilot Study of Obstructive Sleep Apnea Patients and Their Partners.

: Partner involvement can influence positive airway pressure (PAP) therapy use among patients with obstructive sleep apnea (OSA). This study assessed the feasibility, acceptability, and preliminary efficacy of a couples-oriented education and support (CES) intervention for PAP adherence. : Thirty newly diagnosed OSA patients and their partners were randomly assigned to one of three groups: an education and support intervention directed at both patient and partner (CES), an education and support intervention directed only at the patient (PES), or usual care (UC).

Adherence to positive airway pressure treatment among minority populations in the US: A scoping review.

Minority individuals in the United States (US) have an increased prevalence of obstructive sleep apnea (OSA) compared to their white/Caucasian counterparts. In general, adherence to positive airway pressure (PAP) therapy is poor and some studies suggest that PAP use among minority individuals is inferior to that of whites. However, there has not been a review of the evidence that addresses racial-ethnic disparities for PAP adherence in the treatment of OSA, and no review has systematically examined the contributing factors to poor adherence among minority individuals compared to whites.

Motivational Enhancement for Increasing Adherence to CPAP: A Randomized Controlled Trial.

Background: Motivational enhancement (ME) shows promise as a means of increasing adherence to CPAP for OSA.

Methods: We performed an open-label, parallel-arm, randomized controlled trial of CPAP only or CPAP + ME, recruiting individuals 45 to 75 years with moderate or severe OSA without marked sleepiness and with either established cardiovascular disease (CVD) or at risk for CVD. All participants received standardized CPAP support from a sleep technologist; those randomly assigned to CPAP + ME also received standardized ME delivered by a psychologist during two appointments and six phone calls over 32 weeks.

Identifying Longitudinal Patterns for Individuals and Subgroups: An Example with Adherence to Treatment for Obstructive Sleep Apnea.

To improve complex behaviors such as adherence to medical recommendations, a better understanding of behavior change over time is needed. The focus of this study was adherence to treatment for obstructive sleep apnea (OSA). Adherence to the most common treatment for OSA is poor.

Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis.

Few studies have investigated factors associated with continuous positive airway pressure (CPAP) treatment for sleep apnea from the patients' and their partners' perspective. This qualitative research study explored patients' and partners' experiences of CPAP and facilitators and barriers to CPAP use, and elicited suggestions for a first-time CPAP user program. Data from 27 participants were collected via four sleep apnea patient and four partner focus groups.

White matter integrity in obstructive sleep apnea before and after treatment.

Study Objectives: Obstructive sleep apnea (OSA) is commonly associated with cognitive and functional deficits, some of which are resolved after continuous positive airway pressure (CPAP) treatment. The investigation of brain structural changes before and after treatment could provide deep insights into the pathogenesis and the reversibility of this disorder. We hypothesized that severe OSA patients would have altered white matter (WM) integrity and cognition and that treatment would improve both the structural damage and the cognitive impairment.

Spousal involvement and CPAP adherence: a dyadic perspective.

Poor adherence to continuous positive airway pressure (CPAP) treatment is associated with substantial health care costs, morbidity and mortality, and has been a leading obstacle in the effective management of obstructive sleep apnea (OSA). Successful interventions to improve CPAP adherence may ultimately include a variety of components. For patients living with spouses (refers to all domestic partners), the spouse will likely be an integral component to any successful intervention.

Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: a randomized, controlled trial.

Purpose/objectives: To examine the effect of cognitive-behavioral therapy for insomnia (CBTI) on sleep improvement, daytime symptoms, and quality of life (QOL) in breast cancer survivors (BCSs) after cancer treatment.

Design: A prospective, longitudinal, randomized, controlled trial.

Setting: Oncology clinics, breast cancer support groups, and communities in Colorado.

Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial.

Background: Obstructive sleep apnea (OSA) is associated with a variety of medical conditions. Positive airway pressure (PAP) is an effective treatment for improving sleep, yet adherence rates are low. The aim of the current study is to test two treatments versus standard care in improving adherence to PAP.

The association of age, insomnia, and self-efficacy with continuous positive airway pressure adherence in black, white, and Hispanic U.S. Veterans.

Study Objectives: Studies of continuous positive airway pressure (CPAP) adherence in multi-ethnic samples are lacking. This study explores previously described factors associated with therapeutic CPAP use in South Florida veterans with obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods: We performed a retrospective, cross-sectional analysis of CPAP adherence comparing white, black, and Hispanic veterans returning to the Miami VA sleep clinic over a 4-month period.

Adherence to cognitive behavioral therapy for insomnia: a systematic review.

Chronic insomnia is a significant public health problem worldwide, and insomnia has considerable personal and social costs associated with serious health conditions, greater healthcare utilization, work absenteeism, and motor-vehicle accidents. Cognitive behavioral therapy for insomnia (CBTI) is an efficacious treatment, yet attrition and suboptimal adherence may diminish its impact. Despite the increasing use of CBTI, surprisingly little attention has been devoted to understanding the role of adherence.

Obstructive sleep apnea: impact of hypoxemia on memory.

Purpose: Attempts to understand the causes of cognitive impairment in obstructive sleep apnea (OSA) are complicated by the overlap among clinical and demographic factors that may impact cognition. The goal of the current study was to isolate the contribution of hypoxemia to cognitive impairment in OSA.

Methods: Two groups of 20 patients with newly diagnosed OSA were compared.

Sleep-disordered breathing and cognition in older adults.

Both sleep-disordered breathing (SDB) and cognitive impairment are common among older adults, yet few studies have examined their relationship within this population to determine whether the effect of SDB on cognition is of a magnitude similar to or greater than that observed in younger and middle-aged adults. Here, we review the extant literature and report that studies are largely supportive of an association between SDB and cognitive impairment in older adults, particularly in the domains of attention/vigilance, executive function, and verbal delayed recall memory. Presence of the APOE4 allele may confer increased vulnerability to SDB-associated cognitive dysfunction among elderly individuals.

Adherence to cognitive behavioral therapy for insomnia (CBTI) among women following primary breast cancer treatment: a pilot study.

Cognitive behavioral therapy for insomnia (CBTI) has proven efficacy, yet 32%-89% of patients fail to consistently follow recommendations. This pilot study examines adherence to CBTI in breast cancer survivors with insomnia. There was a significant decline in adherence to prescribed rise time, and total time in bed, but no change in adherence to prescribed bedtime during six weekly sessions.

Abstract: Identifying Longitudinal Patterns of Adherence to Treatment for Obstructive Sleep Apnea.

Increasing adherence to medical recommendations is crucial for improving health outcomes and reducing costs of health care. To improve adherence, we have to better understand behavior change over time. The focus of this study was adherence to treatment for obstructive sleep apnea (OSA).

Translational behavioral research in respiratory medicine.

Human behavior can prevent or invite disease and is a major determinant of treatment success. Consequently, many efforts have been directed toward developing interventions to promote behaviors essential to managing or preventing respiratory disease. The process of developing, testing, and disseminating health behavior interventions should closely follow the translational research paradigm.