Date of Award

May 2014

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Jennifer Doering

Committee Members

Rachel Schiffman, Beth Rodgers, Diane Schadewald, Katie Mosack

Keywords

Continuous Positive Airway Pressure, Mild Obstructive Sleep Apnea

Abstract

ABSTRACT

CONTINUOUS POSITIVE AIRWAY PRESSURE USE AND MILD OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS)

by

Michelle L. Nelson

The University of Wisconsin-Milwaukee, 2014

Under the Supervision of Jennifer Doering, PhD, RN

Obstructive sleep apnea syndrome (OSAS) is an increasingly recognized sleep disorder that affects an estimated ten percent of middle-aged women and 25 percent of middle-aged men. Continuous positive airway pressure (CPAP) is the standard treatment for individuals with moderate to severe OSAS. However, it is estimated that 80 percent of individuals with OSAS have a milder form of the disease. The use of CPAP therapy in persons with mild OSAS has not been widely researched and whether CPAP is efficacious in this population remains inconclusive. OSAS has both psychological and physiological effects on people. Two common effects of CPAP use in persons with moderate and severe OSAS are reduced excessive daytime sleepiness (EDS) and reduced blood pressure. The purpose of this study was to examine the effectiveness of CPAP use on blood pressure and EDS in persons with mild OSAS. CPAP use was defined as using CPAP for more than 4 hours per night for more than 70 percent of nights recorded by the CPAP machine.

The study design was a retrospective chart review of electronic medical records (EMR) from a sleep medicine clinic in the southeastern United States. The sample consisted of 60 participants with mild OSAS who were divided into two groups based upon the amount of CPAP use recorded in the EMR (4 or more hours of nightly use 70% of nights, n = 45 and less than 4 hours of nightly use 70% of nights, n = 15). Blood pressure (systolic and diastolic) and daytime sleepiness (Epworth Sleepiness Scale) data were collected on each participant before the initiation of CPAP therapy and at six weeks follow up. Independent samples t-tests were conducted to examine the differences between the groups from baseline to six-week follow-up on the outcome variables. No statistical significance was found for daytime sleepiness (t [34] = .865, p = .393) or either systolic (t [52] = .911, p = .367) or diastolic (t [52] = 1.002, p = .321) pressures. Sleepiness scores in the group who used CPAP four or more hours a night 70% of nights decreased 6.6 points from baseline to 6 weeks, and decreased 8.1 points in the group who used CPAP less than 4 hours a night 70% of the nights. Both groups experienced clinically significant decreases in daytime sleepiness from nearly excessive daytime sleepiness (ESS score >10) before CPAP initiation to nearly no daytime sleepiness at six weeks follow up. There were significant limitations in data collection around both the EMR and the CPAP machine reporting that have implications for practice, research, and policy. Recommendations include standardization of CPAP use reporting across machine type and improving quality around data entry in the EMR. These results support the continued need to research the effectiveness of CPAP in persons with mild OSAS.

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