Improving sleep apnea treatment adherence after traumatic brain injury: A nonrandomized feasibility study.

PURPOSE/OBJECTIVE: To evaluate the feasibility of a psychological intervention designed to increase Positive Airway Pressure (PAP) adherence, adapted with cognitive accommodations for comorbid obstructive sleep apnea (OSA) and traumatic brain injury (TBI). RESEARCH METHOD/DESIGN: This was an open-label single arm (nonrandomized) study. Eligibility criteria were moderate-to-severe TBI, OSA diagnosis, prescribed PAP, nonadherent, and able to consent. Participants were recruited from inpatient and outpatient settings at a tertiary care hospital. The four-module manualized intervention was delivered primarily via telehealth. Feasibility aspects measured included eligibility, recruitment, and retention rates; session duration and attendance; and characteristics of outcome and process measures (e.g., completion rates, data distribution). Symptom measures included the Epworth Sleepiness Scale, Fatigue Severity Scale, Functional Outcomes of Sleep Questionnaire, Self-Efficacy Measure for Sleep Apnea, OSA Treatment Barriers Questionnaire (OTBQ), and Kim Alliance Scale-Revised. RESULTS: Of 230 persons screened, 14.3% were eligible. Recruitment rate (n = 17) was 51.5%. Retention rate (n = 13) was 76.5%. Treatment completers had no missing data. The OTBQ deviated from normality, but other measures had adequate skew (< 2.0) and kurtosis (< 7.0) and were free from significant floor and ceiling effects (<15%). Change score effect sizes were minimal to moderate (d = .10-.77). There were no adverse events. CONCLUSIONS/IMPLICATIONS: These results inform ways in which procedures should be modified to enhance the success of a future clinical trial testing the efficacy of this adherence intervention. Inclusion criteria should be reconsidered, and recruitment sites expanded, to capture eligible persons and adequately power an efficacy study. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"Millionaire Murrays": A qualitative study of formerly homeless veterans who became economically successful.

OBJECTIVE: There have been many clinical anecdotes and empirical studies of homeless individuals who incur high costs for health care, social services, and criminal justice systems, hence the term "Million-Dollar Murray." This study examined individuals who have exited homelessness and have become extremely economically successful, whom we call "Millionaire Murrays." METHODS: After a national recruitment effort, we conducted a qualitative study of formerly homeless veterans who became extremely economically successful. Semistructured interviews were conducted with eight participants to understand their life experiences with homelessness and eventual success beyond housing stability. Interviews were audio-recorded, transcribed, and analyzed using matrix analysis with qualitative techniques. RESULTS: Five overarching themes emerged: Developing Resilience Early, Hitting Rock Bottom, Defining Success Subjectively, Footholds to Success, and Inspiration and Advice. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The findings demonstrate that through a combination of internal and external factors, great economic success is possible in this population. Services should strive to provide more than housing and clinical stability to encourage human flourishing. (PsycInfo Database Record (c) 2023 APA, all rights reserved).