NurseNurse--led Multifaceted Interventions led Multifaceted Interventions Improve Continuous Positive Airway Improve Continuous Positive Airway Pressure Use in Patients with Sleep Pressure Use in Patients with Sleep Apnea SyndromeApnea Syndrome

Department of MedicineDepartment of MedicineNorth District HospitalNorth District HospitalRN Chan WingRN Chan Wing--ChiChi

What is Obstructive Sleep Apnea Syndrome (OSAS)?

characterized by repetitive episodes of upper airway obstruction occur during sleepassociated with a reduction in blood oxygen saturation

Continuous Positive Airway Pressure (CPAP)

Treatment for OSAS

The Myth of Good CPAP Compliance…

Ideal CPAP usage pattern– Use CPAP at effective pressure– During sleep (night/day)– Everyday of the week

In reality, 40-50% of patients do not comply

Reasons for poor compliance

Low patient acceptance/motivation, Early technical problemsInadequate education Limited resource for early close monitoring

Fatal consequences of CPAP Non-Compliance

Fatal RoadAccident

Worsening ofRespiratory

Failure

M yocardialInfaraction

Stroke

Patient

To modify factors influencing CPAP compliance

Nurse-led Multifaceted Intervention (NLMI)

Compare compliance between NLMI group & usual group

NLMI group Vs Usual group

2017 NLMI

USUAL

Baseline characteristics of patients with OSAS

101±1199±10.2Abdominal Girth (cm)

40.6±3.439.7±3.4Neck circumference (cm)

29.2±5.528.2±4.0BMI (kg/m²)1.7±0.081.7±0.08Height (m)82.1±18.577.6±12.4Weight (kg)48±9.448.7±10.6Age (years)

Mean (Usual group)

Mean (NLMI) group

Usual Care in Usual groupUsual Care in Usual group

VideoEducation brochures

Educational talk

Nurse-led Multifaceted Interventions

Multifaceted InterventionMultifaceted Intervention-- comprehensive comprehensive education talk education talk

Physiologic characteristics of patients with OSAS

Multifaceted InterventionMultifaceted Intervention--First week & monthly telephone callsFirst week & monthly telephone calls

Randomized retrospective study in CPAP compliance

Multifaceted InterventionMultifaceted Intervention--Ad hoc & monthly visits to NurseAd hoc & monthly visits to Nurse--led Clinic led Clinic

Nurse-led Multifaceted Interventions

Multifaceted InterventionMultifaceted Intervention--Assessment of own maskAssessment of own mask--wearing technique wearing technique during followduring follow--up at nurseup at nurse--led clinicled clinic

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USUAL NLMI

Mea

n (n

o.of

day

s pe

r w

k)

CPAP compliance : Usage days per week

0

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USUAL NLMI

Mea

n (N

o. o

f hou

rs p

er n

ight

)

CPAP compliance : Usuge hours per day

•Improved CPAP compliance in NLMI group

•Increased frequency of use per week

p=0.048

p=0.0059

Results:

•Increased duration of use

Epw orth Sleepiness Scale Score in Usual Group

ESS pre

ESS post

0 2 4 6 8 10 12 14 16 18 20 22 24

Case 1

case 2case 3

case 4case 5

case 6case 7

case 8case 9

case 10case 11

case 12case 13

case 14case 15

case 16case 17

Result : Slight improvement in Day-time Sleepiness

p=0.001

Epw orth Sleepiness Scale Score in NLMI group

0 2 4 6 8 10 12 14 16 18 20 22 24

Case 1

case 2case 3

case 4

case 5case 6

case 7

case 8

case 9case 10

case 11

case 12case 13

case 14

case 15case 16

case 17

case 18

case 19case 20

ESS post

ESS pre

p<0.0001

Result : Marked improvement in Day-time Sleepiness

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101112

NLMI USUAL

Mea

n (N

o. o

f mon

ths)

Interval betw een clinic visit

Reduction in demand at Specialist Outpatient Clinic in NLMI group

p=0.01

Conclusion:

Nurse-led Multifaceted Intervention: Improved CPAP complianceImproved daytime sleepinessDecreased demand on specialist outpatient clinic

Patients are not the only benefactors of good compliance …. The Healthcare System also benefits through reduction of hospital admissions for related cardiovascular diseases

AcknowledgementMiss. Au Wai-Lin, General Nursing Manager, & Mr. Chan Wing-Fu, DOM Medical , for their long-term support Dr. Choo Kah-Lin, Senior Medical Officer, for the development of the NDH sleep lab. Dr. To Kin-Wang for his valuable advice in the analysis of dataAll colleagues in Medical Department for their understanding & support

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