NIH Awards $3.5 Million to MetroHealth Researcher for Sleep Apnea Study

​The National Institutes of Health has awarded a five-year, $3.5 million grant to support the sleep apnea research of J. Daryl Thornton, MD, MPH, a critical care specialist and pulmonologist and Director of the Division of Pulmonary, Critical Care, and Sleep Medicine at MetroHealth.

Dr. Thornton, who also is Director of the Center for Health Equity, Engagement, Education, and Research (CHEEER) at MetroHealth, and researchers at the University of Pittsburgh have launched the "Improving Sleep in African American Couples" (ISAAC) study.

Obstructive sleep apnea, a condition when breathing stops or becomes shallow during sleep, affects over 25% of adults in the U.S. over age 30, Dr. Thornton said. Worldwide, close to 1 billion people have the condition. Untreated, the condition can lead to excessive sleepiness, motor vehicle accidents, high blood pressure and heart disease.

"Providers who care for patients with sleep apnea often find that the patients are say there's no problem. Instead, it's the bed partner who makes them seek help," he said.

The bed partner may be kept awake at night by the patient's snoring, or may worry that the patient will stop breathing in their sleep. And the bed partner may be more concerned about the excessive sleepiness of the patient, who may brush off their tiredness as what happens after a big meal or while watching TV.

"There can be a lack of awareness that something more serious could going on with their sleepiness, and also a lack of appreciation of the side effects and other conditions that are associated with sleepiness," Dr. Thornton said.

The results of interviews with people with sleep apnea and their bed partners led the researchers to develop an intervention - focusing on the couple, not just the patient - that boosts the use of the most common and effective treatment for sleep apnea: continuous positive airway pressure or CPAP.

Black Americans tend to develop a more severe form of sleep apnea and it may appear at a younger age, Dr. Thornton said. Sleep apnea in Black Americans is under-recognized and under-diagnosed, and clinical trials in that population are very rare. Hence the focus of the research to looked at interventions to improve the care that is delivered.

"We wanted to make the interventions very specific and tailored to that group," he said. "Not to say that those interventions aren't going to work in other groups, but once we prove they work we will be able to replicate it in other groups and see how they respond."

Those tested through MetroHealth or the University of Pittsburgh who are diagnosed with moderate to severe sleep apnea will get a letter in the mail within 48 hours of the test inviting them to join the research project. Starting in early 2025, the trial will enroll a total of 220 couples - patients and their bed partners.

CPAP machines are costly which may be a barrier to optimal treatment. All participants in the study will receive a free CPAP machine and mask that use the same technology as cell phones to help the study team understand how often they are being used. For couples who receive the intervention, the team will provide feedback via text messages to the couple to encourage the patient to use the machine. Intervention couples will also undergo cognitive behavioral (talk) therapy with a trained psychologist to help them overcome barriers to using CPAP. The third part of the intervention will include meetings with peers couples who have had long standing sleep apnea to discuss effective ways to care and cope with it.

"For those that do not participate in the study I hope this study increases their awareness about sleep apnea and encourages them to get checked out to see if they have it," Dr. Thornton said.

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