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Obstructive Sleep ApneaNCT05390138

A Smart Sleep Apnea Self-management Support Programme(4S) for Subjects With Sleep Apnea

A study testing Smart Sleep Apnea Self-management Support Programme (4S) and General Hygiene Information (GH) in people with Obstructive Sleep Apnea, run by The University of Hong Kong.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

OSA is a chronic disease with high prevalence that parallels with increasing obesity. Self-management programmes are perceived to be cost-effective in long-term OSA patient care and can supplement regular medical treatments. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Obstructive Sleep Apnea
What is being tested?
Smart Sleep Apnea Self-management Support Programme (4S) and General Hygiene Information (GH)
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
120 participants
Where
No sites listed yet
Study dates
1 Jun 2022to 20 Dec 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • aged 18 years and above;
  • diagnosis of moderate to severe obstructive sleep apnea (AHI≥15);
  • physically inactive (self-reported moderate physical activity per week of <150 minutes);
  • overweight (BMI≥23 kg/m2);
  • mentally, cognitively and physically fit to join the trial as determined by the doctor in-charge and responsible clinical investigators;
  • able to speak and read Chinese;
Show all 9Show fewer
  • willing to complete the questionnaires and assessments;
  • has a smartphone with instant messaging function (eg. WhatsApp/WeChat); and
  • willing to give informed consent.

Who cannot join

  • sleep disorder other than OSA;
  • clinically significant psychiatric, neurological, or medical disorder other than OSA; and
  • use of prescription drugs or clinically significant drugs affecting sleep.

Trial locations and contacts

No sites are listed yet.

Agnes YK Lai, PhD contact

852-3917-6328

agneslai@hku.hk

George Cheung, MPhil contact

852-3917-7583

ocgeorge@hku.hk

About this study

Official title: A Smart Sleep Apnea Self-management Support Programme(4S) to Improve Apnea Severity and Cardiovascular Health - A Pragmatic Randomized Controlled Trial With Mixed-method Evaluation

OSA is a chronic disease with high prevalence that parallels with increasing obesity. Self-management programmes are perceived to be cost-effective in long-term OSA patient care and can supplement regular medical treatments. The current study attempt to examine the effectiveness of 4S on improving apnea severity, cardiovascular health and quality of life in 4S intervention (4S) group, compared to the general hygiene (GH) control group.

Read the detailed description

OSA is a chronic disease with high prevalence that parallels with increasing obesity. OSA affects around 12% and 24% of adults in Hong Kong and China Mainland, respectively. Chronic intermittent hypoxia and sleep fragmentation of OSA leads to cardiometabolic and neurocognitive sequelae (e.g. hypertension, diabetes, daytime sleepiness and depression). Long-term, multidisciplinary management involving patients in decision-making of treatment strategies, shifting from positive airway pressure (PAP) device-focused to the patient-centered chronic care model has been suggested.

Mobile instant messaging (such as WhatsApp/WeChat) are popular and inexpensive for interactive messaging. Smartphone-based self-management interventions were reported improved self-efficacy and clinical outcomes in patients with chronic diseases. The investigator only found one mobile health application to support CPAP therapy for OSA and one ongoing trial of OSA self-management telematic support to improve CPAP adherence. There is underutilization of mobile technology in patient-centered self-management programmes to improve PAP treatment and lifestyle modifications in OSA.

The current study attempt to examine the effectiveness of 4S on improving apnea severity, cardiovascular health and quality of life in 4S intervention (4S) group, compared to the general hygiene (GH) control group. Questionnaire and simple fitness assessment will be used to assess the effectivness of the intervention at 4-month and 12-month follow-up. Focus group interview will be conducted to collect qualiatative feedback on the intervention.

Being tested
Smart Sleep Apnea Self-management Support Programme (4S), General Hygiene Information (GH)
Medical subject headings
Sleep Apnea, Obstructive

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Smart Sleep Apnea Self-management Support Programme (4S)Behavioural

    Also called 4S group

    The experimental group will receive usual care and Smart Sleep Apnea Self-management Support Programme (4S). The 4S includes two interview sessions, instant messages, phone calls, continuous personalized chat-based messaging and phone call support and hotline services in relation to self-management. An e-platform will be used for self-monitoring and group sharing sessions will be conducted for experience sharing.

  • General Hygiene Information (GH)Behavioural

    Also called GH group

    The control group will receive usual care and general hygiene information (GH). The GH includes two GH sessions, instant messages, phone calls, continuous personalized chat-based messaging and phone call support and hotline services in relation to general hygiene information. An e-platform will be used for self-monitoring and group sharing sessions will be conducted for experience sharing.

Study groups in NCT05390138
Study groupRoleWhat they receive
Smart Sleep Apnea Self-management Support Programme (4S)ExperimentalPatients will receive Smart Sleep Apnea Self-management Support Programme (4S) in addition to usual care
Receives: Behavioral: Smart Sleep Apnea Self-management Support Programme (4S)
General Hygiene Information (GH)Placebo comparatorPatients will receive general hygiene information (GH) in addition to usual care
Receives: Behavioral: General Hygiene Information (GH)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in apnea hypopnea index

    Apnea hypopnea index will be asssessed by sleep test. The apnea hypopnea index is the number of times of apnea or hypopnea during one night, divided by the hours of sleep. The higher the apnea hypopnea index, the more severe sleep apnea is.

    Measured: Baseline, 4 months

Secondary outcomes (26)
  1. Change in apnea hypopnea index

    Apnea hypopnea index will be assessed by sleep test. The apnea hypopnea index is the number of times of apnea or hypopnea during one night, divided by the hours of sleep. The higher the apnea hypopnea index, the more severe sleep apnea is.

    Measured: Baseline and 12 months

  2. Change in Duration of <90% oxygen desaturation

    Duration of <90% oxygen desaturation will be assessed by sleep test.

    Measured: Baseline, 4 months and 12 months

  3. Change in body weight

    Body weight will be measured.

    Measured: Baseline, 4 months and 12 months

  4. Change in body fat

    Body fat will be measured.

    Measured: Baseline, 4 months and 12 months

  5. Change in body neck circumference

    Neck circumference will be measured.

    Measured: Baseline, 4 months and 12 months

  6. Change in waist circumference

    Waist circumference will be measured.

    Measured: Baseline, 4 months and 12 months

  7. Change in hip circumference

    Hip circumference will be measured.

    Measured: Baseline, 4 months and 12 months

  8. Change objective physical activity level

    Steps count and acceleration pattern of physical activity will be measured by a 7-day waist-worn accelerometer.

    Measured: Baseline, 4 months and 12 months

  9. Change in Hand grip strength

    Hand grip strength will be measured by a dynamometer.

    Measured: Baseline, 4 months and 12 months

  10. Change in lower limb strength

    Lower limb strength will be measured by a 30-second chair stand test.

    Measured: Baseline, 4 months and 12 months

  11. Change in flexibility

    Flexibility will be measured by a sit and reach test.

    Measured: Baseline, 4 months and 12 months

  12. Change in balance

    Balance will be measured by a single-leg stance test.

    Measured: Baseline, 4 months and 12 months

  13. Change in daytime sleepiness

    Daytime sleepiness will be measured by a 8-item Epworth Sleepiness Scale with a 3-point Likert scale. Total scores range from 0 to 24. Higher scores reflect greater daytime sleepiness.

    Measured: Baseline, 4 months and 12 months

  14. Change in sleep quality

    Sleep quality will be measured by a 7-item Insomnia Severity Index with a 4-point Likert scale. Total scores range from 0 to 28. Higher scores reflect greater severity of insomnia.

    Measured: Baseline, 4 months and 12 months

  15. Change in functional outcomes of sleep

    Functional outcomes of sleep will be measured by 10-item Functional Outcomes of Sleep Questionnaire with a 4-point Likert scale. Total scores range from 10 to 40. Higher scores reflect better functional outcomes of sleep.

    Measured: Baseline, 4 months and 12 months

  16. Change in quality of life

    Quality of life will be measured by 5-item EuroQol 5-Dimension questionnaire. The EQ-5D descriptive system is a preference-based HRQL measure with one question for each of the five dimensions that include mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

    Measured: Baseline, 4 months and 12 months

  17. Change in anxiety symptoms

    Anxiety symptoms will be measured by Generalised Anxiety Disorder Assessment (GAD-7) with a 3-point Likert scale. Total scores range from 0 to 21. Higher scores reflect more higher anxiety symptoms.

    Measured: Baseline, 4 months and 12 months

  18. Change in depressive symptoms

    Depressive symptoms will be measured by 9-item Patient Health Questionnaire-9 (PHQ-9) with a 3-point Likert scale. Total scores range from 0 to 27. Higher scores reflect more higher depressive symptoms.

    Measured: Baseline, 4 months and 12 months

  19. Change in subjective happiness

    Subjective happiness will be measured by 4-item Subjective Happiness Scale with a 7-point Likert scale. Total scores range from 4 to 28. The highest scores reflect greater happiness.

    Measured: Baseline, 4 months and 12 months

  20. Change in subjective physical activity level

    Subjective physical activity level will be measured by 8-item International Physical Assessment Questionnaire -short version

    Measured: Baseline, 4 months and 12 months

  21. Change in dietary habits

    Dietary habits will be measured by 10-item dietary intake and practice questionnaire.

    Measured: Baseline, 4 months and 12 months

  22. Change in self-efficacy in CPAP use

    Self-efficacy in CPAP use will be measured by a 26-item Self-efficacy Measure for Sleep Apnea. Each Item ranges from 1 to 4: Higher scores indicate greater perceived self-efficacy, greater perceived response efficacy, and higher perceived susceptibility.

    Measured: Baseline, 4 months and 12 months

  23. Change in exercise and dietary control self-efficacy

    Exercise and dietary control self-efficacy will be measured by outcome-based questionnaire. Each item ranges from 1-10. The higher scores indicate higher self-efficacy

    Measured: Baseline, 4 months and 12 months

  24. Change in perceived support from family and peers

    Perceived support from family and peers measured by a 8-item Multidimensional Scale of Perceived Social Support with a 7-point Likert scale. Total scores for both family and peer subscales range from 4 to 28. Higher scores reflect better perceived social support.

    Measured: Baseline, 4 months and 12 months

  25. Change in patient activation

    Knowledge, skills and confidence in self-management were measured by a 13-item Patient Activation Measure Scale. The total score ranges from 0 (no activation) to 100 (high activation), with higher scores denoting the better patient activation.

    Measured: Baseline, 4 months and 12 months

  26. Intervention credibility

    The rationale of the delivered treatment and its efficacy to alleviate sleep apnea will be measured using the 4-item Credibility of Treatment Rating Scale. Each item ranges from 1-6. The higher scores indicate higher credibility.

    Measured: 4 months and 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 May 2022
  2. Study start1 Jun 2022 (estimated)
  3. Primary completion20 Sep 2024 (estimated)
  4. Study completion20 Dec 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a 2-group randomisation controlled trial with 4-month and 12-month follow-up. The Experimental group will receive 4S intervention in relation to self-management and the Control group will receive general hygiene information.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05390138
Sponsor's protocol ID
UW 21-135
Status last verified
May 2022
First submitted
21 Apr 2022
Last updated
25 May 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Need to obtain consent from patients before agreeing to share individual participants data.

Publications

  • Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pepin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687-698. doi: 10.1016/S2213-2600(19)30198-5. Epub 2019 Jul 9.

    PubMed 31300334
  • Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009 Jun 15;5(3):263-76.

    PubMed 19960649
  • Andrade FM, Pedrosa RP. The role of physical exercise in obstructive sleep apnea. J Bras Pneumol. 2016 Nov-Dec;42(6):457-464. doi: 10.1590/S1806-37562016000000156.

    PubMed 28117479
  • Iftikhar IH, Kline CE, Youngstedt SD. Effects of exercise training on sleep apnea: a meta-analysis. Lung. 2014 Feb;192(1):175-84. doi: 10.1007/s00408-013-9511-3.

    PubMed 24077936
  • Aiello KD, Caughey WG, Nelluri B, Sharma A, Mookadam F, Mookadam M. Effect of exercise training on sleep apnea: A systematic review and meta-analysis. Respir Med. 2016 Jul;116:85-92. doi: 10.1016/j.rmed.2016.05.015. Epub 2016 May 21.

    PubMed 27296826
  • Stepnowsky CJ, Palau JJ, Gifford AL, Ancoli-Israel S. A self-management approach to improving continuous positive airway pressure adherence and outcomes. Behav Sleep Med. 2007;5(2):131-46. doi: 10.1080/15402000701190622.

    PubMed 17441783
  • Dickerson SS, Jungquist C, TenBrock E, Aquilina A, Smith P, Sabbah EA, Alameri R, Dean G. Feasibility Testing of a Self-Management Program Book to Improve Adherence to PAP in Persons Newly Diagnosed With Sleep Apnea. Behav Sleep Med. 2018 Sep-Oct;16(5):413-426. doi: 10.1080/15402002.2016.1228644. Epub 2016 Sep 23.

    PubMed 27660897
  • Dickerson SS, TenBrock E, Smith P, Kwon M, Chacko T, Li CS, Dean GE. Mixed methods feasibility study of Breathe2Sleep a peer modeling approach to PAP self-management. Heart Lung. 2020 Nov-Dec;49(6):949-958. doi: 10.1016/j.hrtlng.2020.04.015. Epub 2020 May 28. No abstract available.

    PubMed 32473747
  • Zimbudzi E, Lo C, Misso ML, Ranasinha S, Kerr PG, Teede HJ, Zoungas S. Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis. Syst Rev. 2018 Jun 13;7(1):84. doi: 10.1186/s13643-018-0748-z.

    PubMed 29898785
  • Suarez-Giron M, Garmendia O, Lugo V, Ruiz C, Salord N, Alsina X, Farre R, Montserrat JM, Torres M. Mobile health application to support CPAP therapy in obstructive sleep apnoea: design, feasibility and perspectives. ERJ Open Res. 2020 Feb 10;6(1):00220-2019. doi: 10.1183/23120541.00220-2019. eCollection 2020 Jan.

    PubMed 32055630

Questions about this trial

What is this clinical trial studying?

A study testing Smart Sleep Apnea Self-management Support Programme (4S) and General Hygiene Information (GH) in people with Obstructive Sleep Apnea, run by The University of Hong Kong.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 25 May 2022. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Agnes YK Lai, PhD (852-3917-6328, agneslai@hku.hk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in apnea hypopnea index (time frame: Baseline, 4 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05390138, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 May 2022.

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