Text Message Reminders and Intensive Education Improves Positive Airway Pressure Compliance and Cognition in Veterans with Traumatic Brain Injury and Obstructive Sleep Apnea: ANNIE Pilot Study (P1.097)

Objective: Our objective was to determine if intensive education and text message reminders improved positive airway pressure (PAP) compliance and cognition in veterans with OSA and TBI.

Background: Previous research has shown that patients with both traumatic brain injury (TBI) and obstructive sleep apnea (OSA) have more cognitive problems than patients with TBI alone.

Design/Methods: In this randomized, double-blind, controlled trial, nineteen veterans with chronic stage TBI and newly diagnosed OSA were assigned to receive intensive education at the initial visit and nightly text message reminders to use PAP (reminder group) or to a standard-of-care (SOC) group. Mean percentage overall PAP compliance was averaged over the first seven days and at one month. The Epworth Sleepiness Scale (ESS) and cognitive tests were administered at baseline and 1 month. Effect sizes that incorporated both pre/post and between group differences were calculated.

Results: The reminder group was significantly more compliant with PAP over the first seven days compared to the SOC group (83.94% vs. 55.35%, p=0.04). Reminder group compliance was also greater at 30 days, although not significant (58.85% vs. 36.86%). Twelve patients completed the ESS and cognitive testing at 1 month. Compared to baseline, reminder group ESS scores improved to the normal range (10.14±5.08 to 7.29±4.89) with a medium effect size (d_ppc2 = −0.39). Medium effect sizes were observed in the cognitive domains of attention on the Rey Auditory Verbal Learning Test List B (d_ppc2=0.52), verbal speed of information processing on the Stroop Color Naming test (d_ppc2=0.48), and speeded inhibition on the Stroop Color Word Test (d_ppc2=0.38), which is a measure of executive function.

Conclusions: Intensive education and text message reminders significantly improved PAP compliance. The reminder group showed clinically relevant improvements on subjective sleepiness and on cognitive measures of attention, processing speed and executive function in veterans with TBI and OSA.

Study Supported by:

This research was supported by the 2015 Veterans Affairs VISN 5 New Investigator Grant.

Disclosure: Dr. Kataria has nothing to disclose. Dr. Sundahl has nothing to disclose. Dr. Skalina has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Pfeiffer has nothing to disclose. Dr. Balish has nothing to disclose. Dr. Chapman has nothing to disclose.