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BACKGROUND/RATIONALE:
Obstructive sleep apnea syndrome (OSA) is a common sleep disorder that is associated with serious medical and psychological complications. Nasal continuous positive airway pressure (CPAP) is the treatment of choice for this condition because it is highly effective in reducing the frequency of nocturnal respiratory events, improving sleep architecture, decreasing daytime sleepiness and improving blood pressure. Incomplete patient adherence, however, limits the effectiveness of CPAP therapy and results in sub-optimal patient outcomes. The planned intervention in this project, the Sleep Apnea Self-Management Program (SASMP), is based on the rationale that sleep apnea is a chronic disease that requires significant self-care on the part of the patient. We draw on the extensive chronic disease self-management literature to provide a solid theoretical justification for this pragmatic intervention both to better manage key aspects of OSA and to increase CPAP adherence.
OBJECTIVE(S):
The primary aim of this study is to compare the efficacy of the SASMP to Usual Care for improving OSA symptom status, HRQOL, and self-reported medical utilization. A second aim is to examine the extent to which changes in symptoms and HRQOL are mediated by changes in self-efficacy and CPAP adherence.
METHODS:
The Sleep Apnea Self-Management Program (SASMP) will be evaluated by conducting a randomized, controlled trial of the program compared to Usual Care in patients diagnosed with OSA and prescribed CPAP therapy. Participants randomized to the SASMP group will attend 4 weekly educational sessions of 2.5 hours each. Trained leaders facilitate the program from a scripted manual. Key topics covered in this program include 1) management of OSA symptoms, CPAP side effects, and weight loss; 2) maintaining social contacts and family relationships; and 3) dealing with symptoms of depression and worries about the future.
FINDINGS/RESULTS:
The Sleep Apnea Self-management Program was piloted in 17 participants, who went though four sessions within a one-month period. At the end of the 30-day study period, average CPAP adherence was 5.8 hours/night, which is very close to the optimal level of CPAP use: >6 hours per night. In addition, mean scores on the visual analog scale for sleepiness and the Center for Epidemiological Studies Depression scale were reduced from 7.2 to 5.5 and 11.4 to 6.9, respectively. Outcome expectations scores increased significantly, with a mean score increase from 2.7 to 4.5.
No further changes to project findings at this time.
IMPACT:
The results of this project can improve service delivery and improve health outcomes for sleep apnea patients at the Veterans Affairs San Diego Healthcare System, throughout the VA, as well as to any community based sleep clinic.
No further changes to project impact at this time.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Chronic Diseases
DRE:
Quality of Care, Resource Use and Cost
Keywords:
Self-care, Sleep disorders, Adherence
MeSH Terms:
none
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