Patient and health care provider perspectives of a sleep apnea treatment adherence intervention adapted for persons with traumatic brain injury

To summarize patient perspectives after participating in a behavioral intervention designed to improve adherence to positive airway pressure therapy in Veterans with traumatic brain injury (TBI) and obstructive sleep apnea. The four-module adherence intervention was based on Motivational Interviewing and Cognitive Behavior Therapy principles and was adapted for persons with cognitive impairments. Post-intervention semi-structured interviews were conducted with 13 patients with moderate-to-severe TBI. This qualitative study used a pragmatic and deductive approach with the Health Belief Model as the overarching framework. Two qualitative researchers coded and analyzed data with saturation reached after six interviews. The sample mean age was 51.4 years (SD = 10.8), who were on average 9.4 years post-TBI (SD = 10.1) and 6.8 years (SD = 5.1) post-OSA diagnosis. Patient feedback was organized into four themes that aligned with the Health Belief Model and two themes pertaining to logistics. Participation in this adherence intervention was associated with increased awareness of OSA severity, its impact on them, and treatment benefits. Future research should examine the effectiveness of the intervention in real world clinical settings and obtain consumer input from treating clinicians to optimize the program and patient health and functioning.

本研究旨在总结参与行为干预后患者的视角，该干预旨在改善创伤性脑损伤（Traumatic Brain Injury, TBI）合并阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea, OSA）的退伍军人对持续气道正压通气治疗（Positive Airway Pressure Therapy）的依从性。此项包含四个模块的依从性干预方案基于动机访谈（Motivational Interviewing）与认知行为疗法（Cognitive Behavior Therapy）的原理，并针对认知障碍人群进行了适配调整。干预结束后，研究人员对13名中度至重度TBI患者开展了半结构化访谈。本项质性研究采用务实演绎的研究路径，以健康信念模型（Health Belief Model）作为核心分析框架。两名质性研究人员对访谈数据进行编码与分析，在完成6次访谈后即达到数据饱和。样本的平均年龄为51.4岁（标准差SD=10.8），患者距TBI发病的平均时长为9.4年（SD=10.1），距OSA确诊的平均时长为6.8年（SD=5.1）。患者反馈被归纳为4个契合健康信念模型的主题，以及2个与后勤保障相关的主题。参与此项依从性干预可提升患者对OSA严重程度、其对自身的影响以及治疗获益的认知水平。未来研究应评估该干预方案在真实临床场景中的有效性，并征询接诊临床医师的反馈，以优化该方案，改善患者健康状况与社会功能。