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

> **NIH VA I01** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2026 · —

## 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 

## Key facts

- **NIH application ID:** 11193239
- **Project number:** 5I01HX003221-05
- **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:** 2026
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01T00:00:00 → 2025-09-30T00:00:00

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11193239

## Citation

> US National Institutes of Health, RePORTER application 11193239, Addressing insufficient positive airway pressure use among older Veterans with obstructive sleep apnea (5I01HX003221-05). Retrieved via AI Analytics 2026-07-09 from https://api.ai-analytics.org/grant/nih/11193239. Licensed CC0.

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