Martinez Sergio, Sullivan Jamie, Pasquale Cara, Clark Bill, Malanga Elisha, Deering Sean, Liu Lin, Stepnowsky Carl J
COPD Foundation, Washington, DC, United States.
University of California, San Diego, La Jolla, California, United States.
Chronic Obstr Pulm Dis. 2022 Jul 29;9(3):394-412. doi: 10.15326/jcopdf.2022.0293.
Obstructive sleep apnea (OSA) is a sleep disorder prevalent in >10% of individuals diagnosed with chronic obstructive pulmonary disease (COPD). Continuous positive airway pressure (CPAP) is the first-line therapy for OSA, but many do not use it enough during sleep to effectively manage OSA. The OVERLAP study compared (PC)-structured web-based peer-coaching education and support intervention versus (RC)-education and support based on limited scheduled interactions and patient-initiated contacts.
Participants were primarily recruited from patient communities (COPD, OSA, and the National Patient-Centered Outcomes Research Network [PCORnet]) through electronic methods. Inclusion criteria: ≥40 years old, diagnosis of both COPD and OSA, and currently using CPAP. Participants were then randomly assigned to either the PC or RC group, with outcomes assessed at baseline and 6 and 12 weeks. The primary study outcome was CPAP adherence (hours of use/night) and secondary outcomes were daytime functioning, sleep quality, and daytime sleepiness. Changes in outcomes over time were examined using random effects models.
The study enrolled 332 participants of which 294 were randomized. While groups differed significantly in CPAP adherence at baseline (PC: 6.1±3.1, RC: 7.3±2.4 hours/night; <0.001), there were no significant differences in change of primary and secondary outcomes at either 6 or 12 weeks.
In this group of patients with both COPD and OSA on CPAP therapy, no difference was found between the provision of PC and RC. The study did find unexpectedly high baseline CPAP adherence levels, which suggests that any improvement from the intervention would have been very small and difficult to detect.
阻塞性睡眠呼吸暂停（OSA）是一种睡眠障碍，在超过10%被诊断为慢性阻塞性肺疾病（COPD）的个体中普遍存在。持续气道正压通气（CPAP）是治疗OSA的一线疗法，但许多人在睡眠期间使用不足，无法有效控制OSA。重叠研究比较了基于网络的同伴辅导教育和支持干预（PC）与基于有限的定期互动和患者主动联系的教育和支持（RC）。
主要通过电子方式从患者社区（COPD、OSA和以患者为中心的国家结局研究网络[PCORnet]）招募参与者。纳入标准：年龄≥40岁，诊断为COPD和OSA，且目前正在使用CPAP。然后将参与者随机分配到PC组或RC组，在基线、6周和12周时评估结局。主要研究结局是CPAP依从性（每晚使用小时数），次要结局是日间功能、睡眠质量和日间嗜睡。使用随机效应模型检查结局随时间的变化。
该研究招募了332名参与者，其中294名被随机分组。虽然两组在基线时的CPAP依从性有显著差异（PC组：6.1±3.1，RC组：7.3±2.4小时/晚；<0.001），但在6周或12周时，主要和次要结局的变化没有显著差异。
在这组接受CPAP治疗的COPD和OSA患者中，PC组和RC组之间没有差异。该研究确实发现基线CPAP依从性水平出乎意料地高，这表明干预带来的任何改善都非常小且难以检测到。
