LAUSR

While positive airway pressure (PAP) therapy is the most efficacious and widely used treatment for sleep disordered breathing (SDB), the initial discomfort associated with PAP use and the poor sleep experienced by patients with SDB contribute to treatment non-adherence. Women with SDB report poorer sleep quality and have lower PAP adherence rates than men. Previous interventions to improve PAP adherence have rarely targeted women. Acceptance and Commitment Therapy (ACT) utilizes patient values and mindfulness techniques to promote sustained behavior change. An ACT-based approach, in combination with behavioral sleep improvement recommendations, may improve sleep quality and reduce barriers to PAP adherence. We analyzed data from women veterans with SDB (mean age=53.2 years [range 26-80]; n=90) who participated in a clinical trial of interventions to improve sleep quality and PAP adherence. Participants were randomly assigned to a PAP educational control intervention or an ACT-based intervention, Acceptance and the Behavioral Changes to treat Sleep Apnea (ABC-SA). We measured: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and subjective and objective (actigraphy) sleep efficiency (SE), total sleep time (TST; minutes), and number of awakenings using sleep diary and actigraphy data, respectively. Using mixed-effects models, we examined changes in sleep quality measures at post-treatment and 3-month follow-up, as compared to baseline. Women assigned to the ABC-SA intervention reported significantly greater improvements on PSQI total score (p < 0.001), ISI total score (p< 0.001), diary SE (p< 0.001), and actigraphy SE (p< 0.041), and a decrease in actigraphy TST (p< 0.013) at post-treatment compared to women assigned to the control intervention. These observed changes for the ABC-SA intervention relative to the control intervention were maintained at 3-month follow-up (p≤0.001-0.017). No group differences were observed for diary TST or number of awakenings on diary or actigraphy at post-treatment (p≥0.115) or 3-month follow-up (p≥0.248). An ACT-based approach improved sleep quality in women veterans with SDB, thereby reducing a known barrier to PAP adherence. Future studies should replicate current findings in other at-risk patient groups. This research was supported by the VA HSR&D IIR 16-244. Dr. Martin was supported by VA HSR&D RCS 20-191 and NIH/NHLBI K24 HL143055