# A Multilevel Intervention to Reduce Disparities in Obstructive Sleep Apnea and Related Cardiometabolic Outcomes

> **NIH NIH P50** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2022 · $651,379

## Abstract

ABSTRACT
This application is in response to the RFA-MD-21-007, Centers for Multiple Chronic Diseases Associated with
Health Disparities: Prevention, Treatment, and Management. Project 2 of this application will implement a
multilevel intervention to reduce disparities in the diagnosis and management of obstructive sleep apnea to
improve cardiometabolic outcomes. Specifically, this project will implement a randomized clinical trial to test the
hypothesis that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) and motivational
enhancement therapy (MET) therapy in Black and Hispanic patients improves adherence to PAP therapy and
downstream sequelae including blood pressure, glycemic profiles, and quality of life. OSA-related Intermittent
hypoxemia and sleep fragmentation activate the sympathetic nervous system, increase oxidative stress, and
heighten systemic inflammation. These perturbations can increase blood pressure, decrease insulin sensitivity
and impair β-cell function, and impact quality of life. Poor adherence to PAP therapy is most notable in minority
populations, reflecting multiple individual, and health system level challenges. Over the last decade various
strategies to augment adherence to PAP therapy have been rigorously sought. One successful approach is the
use of MET to improve adherence MET, which is based on the principles of motivational interviewing, is designed
to promote self-efficacy and maximize behavioral change. To address feasibility of implementing MET in
Federally Qualified Health Centers (FQHC), where access to sub-specialized sleep care is less likely, we
propose screening for and diagnosing OSA using the electronic health record, at home sleep apnea tests, and
training community health workers (CHW) to implement MET. The central scientific premise of this application is
that MET, implemented by CHW trained in motivational interviewing, can improve PAP adherence. Our approach
of using CHWs will provide a feasible, generalizable, and scalable approach to tackling the common problem of
poor PAP adherence in the underserved. Our Specific Aims are as follows. Aim 1: To compare the impact of
MET, with specific attention to social, physical, psychological and environmental barriers (social determinants of
health), delivered by culturally congruent CHWs versus an attention-matched comparator (consisting of
comparable number of calls to discuss general sleep hygiene) on: (a) PAP adherence, (b) blood pressure, (c)
24-hr glycemic profiles, (d) daytime sleepiness, and (e) quality of life at 90 days. Aim 2: To compare the 3, 6,
and 12 month healthcare utilization patterns and costs of care of OSA patients in each study arm. Given the high
prevalence of OSA and medical comorbidities in the minority populations, findings from this trial would have a
major impact on both clinical practice and public health, justifying early case identification and treatment of OSA
in underserved populations.

## Key facts

- **NIH application ID:** 10494172
- **Project number:** 5P50MD017347-02
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Naresh M Punjabi
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $651,379
- **Award type:** 5
- **Project period:** 2021-09-24 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10494172

## Citation

> US National Institutes of Health, RePORTER application 10494172, A Multilevel Intervention to Reduce Disparities in Obstructive Sleep Apnea and Related Cardiometabolic Outcomes (5P50MD017347-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10494172. Licensed CC0.

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