Health Coaching for Sleep Apnea
(REST pilot Trial)
Recruiting in Palo Alto (17 mi)
Overseen byRachel Willard-Grace, MPH
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of California, San Francisco
Disqualifiers: Non-English/Spanish, Under 18, No phone
No Placebo Group
Trial Summary
What is the purpose of this trial?This study will test a brief telephonic health coaching intervention to improve adherence to positive airway pressure therapy for treatment of obstructive sleep apnea.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment health coaching for sleep apnea?
Research shows that health coaching can help people with sleep apnea lose weight and adopt healthier lifestyles, which are important for managing the condition. In one study, patients who received coaching lost weight and improved their body composition, which can positively impact sleep apnea.
12345Is health coaching safe for humans?
Health coaching, including Erickson coaching and programs like HealtheSteps™, has been used safely in various settings to support lifestyle changes for conditions like obesity, diabetes, and heart disease. Participants and coaches generally find these programs acceptable and helpful, with no significant safety concerns reported.
15678How does health coaching differ from other treatments for sleep apnea?
Health coaching for sleep apnea is unique because it focuses on lifestyle changes and weight management through personalized coaching sessions, unlike traditional treatments like CPAP (continuous positive airway pressure) which primarily address breathing issues during sleep. This approach aims to improve adherence to healthy behaviors, potentially leading to weight loss and better overall health outcomes.
1591011Eligibility Criteria
The REST study is for English or Spanish speakers over 18 who have sleep apnea and got a modem-enabled airway pressure device from San Francisco General Hospital Sleep Clinic but aren't using it enough (less than Medicare's standard). They need to be reachable by phone.Inclusion Criteria
You have received treatment at the San Francisco General Hospital Sleep Clinic.
English- or Spanish-speaking
At least 18 years of age
+2 more
Exclusion Criteria
Not English- or Spanish-speaking
Younger than 18 years
Does not have phone number at which could be reached
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive telephonic health coaching to improve adherence to positive airway pressure therapy
4 months
Up to 5 calls (telephonic)
Follow-up
Participants are monitored for adherence and patient-reported outcomes such as daytime sleepiness
4 months
Participant Groups
This trial tests if a short health coaching program done over the phone can help people with obstructive sleep apnea stick to their positive airway pressure therapy better.
2Treatment groups
Experimental Treatment
Active Control
Group I: Health coaching armExperimental Treatment1 Intervention
For the health coaching arm, an unlicensed, trained health coach will call patients up to five times to identify and resolve barriers to adherence, including lack of understanding of their condition or the treatment, discomfort in acclimating to treatment, technical difficulties in mask fit or device settings, and challenges in navigating durable medical equipment providers.
Group II: Usual careActive Control1 Intervention
Patients assigned to usual care have access to all other available resources, including technical support from durable medical equipment providers, respiratory therapist visits with the Sleep Clinic, group visits, or visits with their primary care provider.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Zuckerberg San Francisco General Hospital Sleep ClinicSan Francisco, CA
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Who Is Running the Clinical Trial?
University of California, San FranciscoLead Sponsor
References
Erickson solution-focused coaching for weight management in obese patients with obstructive sleep apnoea: ECOHEALTH pilot study. [2021]Coaching as a lifestyle modification approach to weight management is insufficiently explored in obstructive sleep apnoea. We investigated anthropometry and body composition after 20 weeks of Erickson coaching in 26 obstructive sleep apnoea patients (19 males; 47.6 ± 2.4 years). Body weight, neck circumference, waist-to-hip ratio and %body fat significantly decreased after 20 weeks. The mean weight loss was 5.2 per cent ± 1.0 per cent; 20 (77%) participants achieved target reduction of >3 per cent. Coaching session attendance (p = 0.006) and reaching personal goal related to physical performance (p = 0.044) were independently associated with weight loss (multiple regression model R2 = 0.608, p < 0.001). Erickson solution-focused coaching supports adherence to healthy lifestyle and weight reduction in obstructive sleep apnoea.
[Coaching and diabetes]. [2011]Coaching is a process of change to achieve goals. The patient coaching focuses on the health goals: to implement preventive or chronic treatment [1]. It is with the patient to create a space that facilitates the exchange of thoughts, attitudes, behavior... In short, achieve improvements in a more rapid and efficient if not practiced. Further explanation can be found in the author's book entitled "Coaching and health".
Impact of an Extended Telemonitoring and Coaching Program on Continuous Positive Airway Pressure Adherence. [2022]Rationale: The benefits of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea are limited by adherence. Telemonitoring and coaching have been demonstrated to increase adherence, but the ideal duration of such support is unclear. Objectives: To compare the impact of a 12-month versus a 3-month behavioral support program on CPAP adherence. Methods: We evaluated real-world CPAP adherence data from all patients initiating CPAP between July 1, 2018, and April 1, 2020, by any durable medical equipment (DME) providers who had used a 12-month commercially available telemonitoring/coaching program (Long Term Adherence Management, Philips Respironics) in this timeframe. Patients receiving either 12 months or 3 months of support (Patient Adherence Management Service) were compared with those initiated on CPAP without support. Mean CPAP adherence was computed monthly over the initial 18 months. Missing usage was imputed as zero use. All analyses were adjusted for age, sex, and DME provider. Results: The nine DME providers using the 12-month telemonitoring/coaching service cared for a total of 26,489 patients (3,264 receiving 12-month support, 15,424 receiving 3-month support, and 7,801 receiving no support) in the timeframe under study. In adjusted analyses, mean CPAP use in the 3-month support group was greater than the no support group in Month 3 (4.6 h vs. 4.3 h; P < 0.001) but subsequently, usage declined to match the no support group at both Month 12 and Month 18. In contrast, mean CPAP use was greater in the 12-month support group than in the no support group at Month 3 (4.6 h vs. 4.3 h; P < 0.001), Month 12 (4.0 h vs. 3.6 h; P < 0.001), and Month 18 (3.3 h vs. 3.2 h; P = 0.02). Conclusions: A 3-month telemonitoring/coaching program increases CPAP use in the short term but does not lead to sustained improvements. In contrast, a 12-month program leads to sustained improvements but results still diminish once coaching ceases. Implementation of longer-term telemonitoring and coaching programs may be vital to obtaining long-term benefits from CPAP therapy.
Eight-year post-trial follow-up of morbidity and mortality of telephone health coaching. [2021]Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF)..
Erickson health coaching: An innovative approach for weight management in obese patients with obstructive sleep apnoea? [2019]Obstructive sleep apnoea (OSA) is a highly prevalent medical condition and amajor cardiovascular risk factor. Obesity is present in ∼70% of patients with OSA, nevertheless, continuous positive airway pressure (CPAP) ventilation - the gold standard therapy for moderate and severe OSA - has no appreciable long-term beneficial effects on obesity, body composition, energy metabolism, physical activities or the incidence of major cardiovascular events. Therefore, effective weight loss strategies in conjunction with CPAP therapy in OSA are critically needed. Since lifestyle interventions may positively impact body weight, there is a strong rationale to testing the hypothesis that Erikson coaching intervention as a form of lifestyle intervention to obese patients with OSA may increase their adherence to healthy lifestyle behaviour and thus result in weight reduction, improved body composition (reduction in %body fat) and improvements in glucose and lipid metabolism. There are three lines of evidence to justify testing this hypothesis: First, health coaching significantly facilitates uptake of healthy behaviours across a broad variety of chronic conditions; second, several randomized clinical trials suggested positive impact of health coaching on weight management and on cardiometabolic risk factors in overweight/obese otherwise healthy persons; third, Erickson coaching approach empowers the three key elements of health coaching (patient-centeredness, patient-determined goals, use of a self-discovery process) further, namely by introducing two other specific core elements into the coaching process: a) solution-focus and outcome frame, b) orientation at the patient-formulated positive outcomes (i.e., positive values resulting from behavioural change). Importantly, results of our recent pilot observational cohort study suggested that Erickson coaching is a powerful tool to address behavioural modification in obesity. In conclusion, testing our hypothesis may have significant clinical implications: if clinical randomized trials indicate that Erickson health coaching is an efficient approach to behavioural change and weight management in OSA then combining Erickson coaching with CPAP therapy may result in reductions in cardiovascular morbidity and mortality in these high-risk patients.
[Health counseling in primary care doctors' offices: a new wind! The Health Coaching Program of the Swiss College of Primary Care Medicine]. [2015]The Health Coaching Program facilitates health behavior counseling in all areas of primary medical care: prevention, therapy and rehabilitation, i.e. wherever the patient is the decisive agent of change. Health Coaching gives the patient the main role. The physician becomes his coach. Health Coaching offers skills training and simple algorithms with a colour-coded visual tool to assist patient and physician through the 4 steps of developing awareness, building motivation, preparing a personal health project and implementing it. Health Coaching was tested successfully by 20 family doctors during 12 months: of 1045 patients invited 91% enrolled; 37% completed all four steps; one half achieved a positive behavior change. Acceptance and feasibility were high in physicians and patients. Nationwide dissemination is now in preparation.
Compendium of the Health and Wellness Coaching Literature. [2020]Health and wellness coaching (HWC) for lifestyle behavior change is emerging as a practice, role, and profession, in diverse health care, employee wellness, and community settings. Health care professionals apply HWC as a behavior change methodology for the prevention and treatment of diabetes, hypertension, hyperlipidemia, heart disease, cancer, and other chronic disorders. The purpose of this systematic review was to provide a comprehensive and organized compendium of HWC literature. To date, extant HWC literature remains scattered with no meaningful summary accessible. Lack of comprehensive summary stems from lack of consensus on HWC definition and standards. We applied a recently proposed, standardized definition of HWC to determine compendium inclusion criteria for peer-reviewed, data-based literature from relevant search engines (ie, PubMed, PsychInfo, and CINAHL). A systematic review process was executed and ultimately yielded 219 articles meeting HWC inclusion criteria. Of these, 150 were data-based and the remainder were expert opinion or review-style articles. A summary of results generally reveals HWC as a promising intervention for chronic diseases though further research is needed in most categories. The resulting HWC compendium organizes and describes the quantity and quality of available literature for the use and benefit of HWC practitioners and researchers.
Process evaluation of the HealtheSteps™ lifestyle prescription program. [2019]Physical inactivity, sedentary behavior, and poor diet are contributing to the rise in chronic disease rates throughout the world. HealtheSteps™ is a lifestyle prescription program focused on reducing risk factors for chronic disease through in-person coaching sessions, goal setting and tracking, and technology supports. A process evaluation was conducted alongside a pragmatic randomized controlled trial to: (a) explore the acceptability of HealtheSteps™ program from coach and participant perspectives; and (b) identify where the program can be improved. Participants at risk or diagnosed with a chronic disease were recruited from five primary care/health services organizations into HealtheSteps™. Participants met with a trained coach bi-monthly for 6 months and set goals for physical activity (step counts), exercise (moderate to vigorous activity), and healthy eating. Coaches were interviewed at month 6 and participants at month 12 (6 months postprogram). All coach interviews (n = 12) were analyzed along with a purposeful sample of participant interviews (n = 13). Coaches found that HealtheSteps™ was easy to deliver and recommendations for exercise and healthy eating were helpful. Including discussions on participant readiness to change, along with group sessions, and more in-depth healthy eating resources were suggested by coaches to improve the program. Participants described the multiple avenues of accountability provided in the program as helpful. However, more feedback and interaction during and postprogram from coaches were suggested by participants. HealtheSteps™ is an acceptable program from the perspectives of both coaches and participants with suggested improvements not requiring significant changes to the core program design.
CPAP devices: encouraging patients with sleep apnea. [2022]Continuous positive airway pressure devices (CPAP) used at night prevent apnea, hypoxia, and sleep disturbance. Although CPAP is more effective than placebo in improving sleepiness and quality of life measures in people with obstructive sleep apnea, patients often prefer a less-effective oral appliance. This article examines help-seeking experiences in support groups of individuals with sleep apnea who use CPAP devices. To understand patients' experiences and difficulties using CPAP, an urban medical center and a rural hospital shared data collected from 17 individuals with sleep apnea who use CPAP for treatment and attend a support group. Four related themes emerged including (a) becoming motivated to persist with help from the group, (b) accommodating to the device, (c) listening and telling stories to gain practical knowledge, and (d) implementing a support group as a caring community. Healthcare providers could recommend support groups on CPAP use while nurses guide discussion, provide technical information, and promote empowerment.
Effect of Mediterranean diet versus prudent diet combined with physical activity on OSAS: a randomised trial. [2022]We aimed to evaluate the effect of the Mediterranean diet (MD) compared with a prudent diet (PD) combined with physical activity on obese obstructive sleep apnoea syndrome (OSAS) patients who were treated with continuous positive airway pressure. 900 patients were evaluated and 40 obese patients (body mass index ≥ 30.0 kg · m(-2)) who met the inclusion criteria, with moderate-to-severe OSAS (apnoea-hypopnoea index (AHI) >15 events · h(-1) and Epworth Sleepiness Scale score >10) based on overnight attended polysomnography, were included in the study. After randomisation, 20 patients followed the MD and 20 a PD for a 6-month period. All patients were counselled to increase their physical activity. Concerning sleep parameters, only AHI during rapid eye movement (REM) sleep was reduced to a statistically significant degree, by mean ± SD 18.4 ± 17.6 events · h(-1) in the MD group and by 2.6 ± 23.7 events · h(-1) in the PD group (p
How to assess, diagnose, refer and treat adult obstructive sleep apnoea: a commentary on the choices. [2019]Obstructive sleep apnoea (OSA) determined by polysomnography is highly prevalent, affecting about 25% of men and 10% of women in the United States, although most have few or no symptoms. Symptomatic moderate to severe OSA has major health implications related to daytime sleepiness, such as increased accidents, altered mood and loss of productivity in the workplace. Severe OSA may increase the risk of cardiovascular disease independent of daytime sleepiness. A major challenge is to correctly identify, from the large community pool of disease, people with symptoms and those at risk of long-term complications. For treatment plans to achieve quality patient outcomes, clinicians must have a clear understanding of patients' symptoms and their motivations for presentation, and be knowledgeable about the evidence surrounding the health risks of OSA and the relative merits of the various diagnostic and treatment options available. The diagnosis of OSA represents a teachable moment to target adverse lifestyle factors such as excessive weight, excessive alcohol consumption and smoking, which may be contributing to OSA and long-term cardiometabolic risk. OSA assessment and management has traditionally involved specialist referral and in-laboratory polysomnography. However, these services may not always be easy to access. Controlled studies have shown that patients with a high pretest probability of symptomatic, moderate to severe OSA can be managed well in primary care, or by skilled nurses with appropriate medical backup, using simplified ambulatory models of care. The future of sleep apnoea assessment and management will likely include models of care that involve early referral to specialists of patients with complex or atypical presentations, and an upskilled and supported primary care workforce to manage symptomatic, uncomplicated, high pretest probability disease.