# Improving Sleep Apnea Treatment Adherence after Brain Injury:  A Feasibility Study

> **NIH VA I21** · JAMES A. HALEY VA MEDICAL CENTER · 2021 · —

## Abstract

Background: Obstructive sleep apnea (OSA) is a sleep disorder that commonly occurs in Veterans
with moderate-to-severe traumatic brain injury (TBI). Untreated OSA increases risk of poor health
outcomes including cognitive impairment, declining mental health, poor physical health, and
premature mortality. Positive airway pressure (PAP) is the frontline treatment for OSA that
effectively reduces the many negative health consequences of the disease. However, adherence to
PAP is required to reap the therapeutic benefit. Unfortunately, PAP adherence is poor. Our recent
study showed that 68% of Veterans with moderate-to-severe TBI and OSA were nonadherent to
PAP therapy. Psychoeducation is part of the standard of care for OSA treatment with PAP, but on
its own is insufficient for improving PAP adherence. Alternatives to the standard of care include
evidence-based behavioral interventions such as Motivational Interviewing (MI) and Cognitive-
Behavioral Therapy (CBT) which have been shown to increase PAP use and improve PAP
adherence in persons without TBI. Unfortunately, these evidence-based interventions (designed for
cognitively intact individuals) have not been adapted to address PAP adherence in persons with
moderate-to-severe TBI, who often require cognitive accommodations. The goal of this study is to
test the feasibility of a novel 4-session manualized intervention, designed with cognitive
accommodations, and informed by MI and CBT, to address PAP adherence in Veterans with TBI
and OSA. Study Aims: Study Aim 1 will test the feasibility and acceptability of delivering the PAP
adherence intervention. Study Aim 2 will evaluate the feasibility of outcome and process measures.
To date, no treatment exists to ameliorate the adverse consequences of moderate-to-severe TBI.
OSA is a treatable health condition that commonly co-occurs with TBI, which is a leading cause of
long-term disability. Method: We will recruit 19 Veterans from inpatient and outpatient TBI and
sleep clinics at this hospital. Those meeting eligibility criteria (diagnosis of OSA and moderate-to-
severe TBI; nonadherent to PAP, able to provide informed consent) will be invited to participate in
the 4-session intervention followed by a qualitative interview to inquire about intervention
acceptability. Study measures (e.g., symptom severity, sleep quality of life), will be administered
pre- and post-intervention. Adherence will be measures via objective data from hospital software
which monitors PAP use. Expected Outcomes and Significance: This innovative study will be
the first to develop, test, and refine a clinical intervention designed to enhance PAP adherence
using cognitive accommodations specifically for persons with moderate-to-severe TBI. If the
intervention is shown to be feasible, results from this study will be used to refine the intervention,
and in a future randomized control trial, test the efficacy of the adapted intervention versus
treatment as usual in improving adherence...

## Key facts

- **NIH application ID:** 10128210
- **Project number:** 5I21RX003303-02
- **Recipient organization:** JAMES A. HALEY VA MEDICAL CENTER
- **Principal Investigator:** Marc A. Silva
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-04-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10128210

## Citation

> US National Institutes of Health, RePORTER application 10128210, Improving Sleep Apnea Treatment Adherence after Brain Injury:  A Feasibility Study (5I21RX003303-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10128210. Licensed CC0.

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