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 intervention evaluated in this project, the Sleep Apnea Self-Management Program (SASMP), was based on the rationale that sleep apnea is a chronic disease that requires significant self-care on the part of the patient. SASMP was based on the extensive chronic disease self-management literature, which provided a solid theoretical justification for this pragmatic intervention both to better manage key aspects of OSA and to increase CPAP adherence.
The primary aim of this study was to examine the effect of the SASMP, compared to Usual Care, on CPAP adherence. A second aim of the study was to examine the effect of the SASMP, compared to Usual Care, on proposed mediating variables derived from social cognitive theory (perceived self-efficacy, outcome expectations). And the third aim of the study was to measure the short- and long-term effects of the SASMP, compared to Usual Care, on health outcomes (e.g., OSA symptoms and OSA-specific HRQOL).
The Sleep Apnea Self-Management Program (SASMP) was 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 attended 4 weekly educational sessions of approximately two hours each. A trained leader facilitated the program from a scripted manual. Key topics covered in this program included: (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.
The main finding of the study was that participation in the Sleep Apnea Self-Management Program resulted in higher CPAP adherence at the one-month time point relative to participation in the Usual Care group. Nightly CPAP adherence measured over the one-month period was 2.8 2.6 vs. 3.9 2.4 hours per night (p=.001) for the Usual Care and Self-Management and groups, respectively. On measures of Social Cognitive Theory, including self-efficacy and outcome expectations, the participants who attended the SASMP had higher scores than participants who went through Usual Care. However, the study did not find an effect on self-reported sleep or sleep apnea symptoms, health-related quality of life or depressive symptoms.
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.
- Stepnowsky CJ, Ancoli-Israel S. Sleep and Its Disorders in Seniors. Sleep medicine clinics. 2008 Jan 1; 3(2):281-293.
- Stepnowsky CJ, Palau JJ, Marler MR, Gifford AL. Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy in obstructive sleep apnea. Journal of Medical Internet Research [Electronic Resource]. 2007 May 17; 9(2):e14.
- Stepnowsky CJ, Palau JJ, Gifford AL, Ancoli-Israel S. A self-management approach to improving continuous positive airway pressure adherence and outcomes. Behavioral sleep medicine. 2007 Apr 1; 5(2):131-46.