Effect of Self-Management on Improving Sleep Apnea Outcomes
Effect of Self-Management on Improving Sleep Apnea Outcomes
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. Previous efforts to enhance CPAP adherence have resulted in only modest
 improvements, have generally not been theory-driven, and have had minimal effects on key
 patient outcomes such as reduction in OSA symptoms or increase in health-related quality of
 life (HRQOL). The planned intervention in this proposal, 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. Chronic disease management programs help reduce symptoms, improve HRQOL, improve
 treatment adherence, and decrease medical utilization.
Background: 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. Previous efforts to enhance CPAP adherence have resulted in only modest
 improvements, have generally not been theory-driven, and have had minimal effects on key
 patient outcomes such as reduction in OSA symptoms or increase in health-related quality of
 life (HRQOL). The planned intervention in this proposal, 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. Chronic disease management programs help reduce symptoms, improve HRQOL, improve
 treatment adherence, and decrease medical utilization. Objectives: 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: We will evaluate the Sleep Apnea Self-Management Program (SASMP) 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. Two 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: No results at this time. Status: We are currently engaging in start-up activities.
 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.
Inclusion Criteria:

 -  Clinical diagnosis of obstructive sleep apnea

 -  No previous use of CPAP

 -  Must be a Veteran with residence within San Diego County

 Exclusion Criteria:

 -  Home oxygen therapy

 -  Fatal comorbidities (i.e., life expectancy less than 6 mos)

 -  Contraindications for CPAP use