# Addressing insufficient positive airway pressure use among older Veterans with obstructive sleep apnea

> **NIH VA I01** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2024 · —

## Abstract

Background: The most frequently diagnosed sleep disorder among older Veterans is obstructive sleep apnea
(OSA), which is associated with serious adverse effects on health, quality of life and survival. Positive airway
pressure (PAP) is recommended as first-line treatment (particularly for moderate to severe OSA), but
sustained use is difficult to achieve, including among older Veterans, and nearly half of patients with OSA who
begin PAP therapy discontinue use within a year.
Significance/Impact: Although OSA is a chronic condition, research to date has primarily focused on increasing
initial PAP use in patients with newly diagnosed OSA. In addition, most research has not addressed PAP use
in older adults, which is unfortunate given the high prevalence and important adverse effects of OSA on their
health and well-being. Prior work suggests that behavioral interventions are effective in improving initial PAP
use, but little is known of how to address insufficient use over time.
Innovation: To address this problem, we developed and pilot-tested a structured, manual-based approach to
address insufficient PAP use among older adults with previously diagnosed OSA. The intervention (5 sessions
over 8 weeks, then monthly contact for up to 6 months) is designed so it can be provided by individuals (“sleep
coaches”) from various disciplines (supervised remotely by a psychologist) in a variety of settings for maximal
implementation. Core components of the intervention include: 1) educational and behavioral approaches to
improve PAP use, 2) individualized self-management and troubleshooting techniques to address factors
contributing to insufficient PAP use, and 3) ongoing review of objective PAP use (via remote monitoring).
Specific Aims: Primary Aim 1 will test the efficacy of this intervention for improving PAP usage among older
Veterans with previously diagnosed OSA who have insufficient PAP use. Our hypotheses are that the
intervention will increase objectively measured PAP use at 6-months follow-up, with effects sustained at 12
months. Secondary Aim 2 will test for effects on sleep quality, daytime sleepiness and sleep-related function;
and Exploratory Aim 3 will test for effects on health-related quality of life. Our hypotheses are that these
outcomes will also improve at 6 months, and effects will be sustained at 12 months.
Methodology: We propose a randomized, controlled trial to test this new intervention in older Veterans (aged >
65 years, N=90) with previously diagnosed OSA (moderate to severe) who were prescribed PAP 1-5 years in
the past, but have insufficient PAP use (defined as no PAP use over the prior 30 days). Given prior growing
interest in telehealth and remote monitoring approaches to optimize PAP use, and the ongoing COVID-19
pandemic, all aspects of the study will be performed virtually in keeping with the latest VA COVID-era guidance
for the remote testing and treatment of OSA. Participants will be randomized to the intervention or a c...

## Key facts

- **NIH application ID:** 11006244
- **Project number:** 5I01HX003221-04
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Cathy Ann Alessi
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11006244

## Citation

> US National Institutes of Health, RePORTER application 11006244, Addressing insufficient positive airway pressure use among older Veterans with obstructive sleep apnea (5I01HX003221-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/11006244. Licensed CC0.

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