LAUSR

Sleep disordered breathing (SDB) is associated with a myriad of health conditions yet is often underrecognized in women. Positive airway pressure (PAP) therapy is first line therapy for SDB; however, adherence rates are low, with women in the U.S. having lower PAP adherence than men. In studies of veterans, published research has not evaluated interventions specifically for women with SDB. Acceptance and Commitment Therapy (ACT) is a technique that utilizes individuals’ values, commitment to change, and mindfulness techniques to promote behavioral change and may be an effective technique in improving PAP adherence among women veterans. We analyzed data from women veterans newly diagnosed with SDB who agreed to try PAP therapy (mean age=53.2 years [range 26-80], 30% African American, 28% Hispanic; n=90) who participated in a randomized controlled trial comparing an ACT-based intervention (Acceptance and Behavioral Changes to treat Sleep Apnea - ABC-SA; n=44) to a PAP educational control (n=46). Remote monitoring was used to determine days of PAP usage, days PAP used > 4 hours (main outcome), and hours of PAP used per month for the first 3 months of use. We used mixed models to compare changes in PAP adherence measures between groups over the first 3 months of use. In the ABC-SA group, mean nights of use were 20.9, 14.9, and 11.5 for months 1, 2, and 3 respectively, versus 16.9, 11.0, and 8.7 in the control group, with a non-significant trend towards more nights of use in the ABC-SA group in month 1 (p=0.056). There were no significant differences between ABC-SA and control in other PAP use outcomes in months 1, 2 or 3. An ACT-based approach did not improve PAP adherence in women veterans over the first three months compared to education alone. Future studies are needed to evaluate whether subgroups may benefit from more intensive interventions such as ABC-SA and to evaluate interventions for improving PAP use long-term. 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.