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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
0
1
2
3
4
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7
USUAL NLMI
Mea
n (n
o.of
day
s pe
r w
k)
CPAP compliance : Usage days per week
0
1
2
3
4
5
6
7
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
0123
456789
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
The EndThe End
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