The Effectiveness of Integrated Nursing Education on Quality of Life and Health Related among Obstructive Sleep Apnea Patients with Continuous Positive Airway Pressure Therapy

Purpose:

The purpose was to examine the effectiveness of quality of life and health related after nursing education among obstructive sleep apnea (OSA) patients with continuous positive airway pressure (CPAP) therapy.

Methods:

The experimental group received CPAP nursing care and the control group received routine care. The collection data of the both groups involved before intervention (pre-test), post-test (the 7^th day after the intervention), and post post-test (the 30^thday after the intervention).

SPSS 17.0 was used, which included descriptive statistics, Chi-Square, Generalized Estimating Equation (GEE), and Analysis of Covariance (ANCOVA) for data analysis. The reliability test of effectiveness indicators were diagnosed with OSA patients received CPAP therapy bysleep center chest medicine physician. The subjects treated with CPAP for first time home use in an outpatient clinic of teaching hospital from July 18, 2013 to April 03, 2014. 55 valid subjects were in the study including 25 subjects in the control group and 23 subjects in the experimental group. There were seven subjects withdraw from the study. The withdraw rate was 12.7%. GEE analysis was used for the two groups before intervention (pre-test), post-test  (the 7^th day after the intervention), and post post-test (the 30^thday after the intervention) to repeat measurements of health status, the time of using CPAP, and the Calgary Sleep Apnea Quality of Life Index (SAQLI).

Results:

The results showed that: (1) the health status domain, the ESS, AHI, BMI, and NC in the 7^th day and the 30^th day after the intervention had improved on the experimental group than control group, but was not significant difference. (2) the time of using CPAP domain, there was reducing the time on the 30^th day after intervention compared with the control group, but no significant difference. (3) the difficulties of using CPAP domain, there improved on the experimental group compared the control group in the 30^th day after intervention, and was statistically significant difference (β = -1.834, p = .040). (4) the self care ability of using CPAP domain, there increased the 30^th day after intervention in the experimental group than the control group, but no significant difference. (5) SAQLI domain, the mean of SAQLI score was calculated by professor Flemona suggestion. The SAQLI mean score at pre-test was 4.18 points, post test (the 7^th day after the intervention) was 4.31 points, post post-test (the 30^thday after the intervention) was 4.35 points in the experimental group, which indicated the quality of life index increased with the time of the intervention. The results showed that a trend of continuous improvement after intervention. Particularly, there was most improving in

the first seven days after the intervention. In addition, the mean quality of life index at the pre-test points was 4.20 points, at post test (the 7^th day after the intervention) was 3.75 points getting worse, and post post-test (the 30^th day after the intervention) was 3.89 points slightly improved in the control group. The total score of SAQLI improved and significant difference (β = 1.669, p = 0.014) at the 30^th day after the intervention in the experimental group. Another symptoms of the SAQLI sub-item improved and significant difference (β=5.69 p. =0.007) at the 30^thday after the intervention in the experimental group, the other variables no significant difference.

Conclusion:

Based on the results of the study, the difficulties of using CPAP, the symptoms of SAQLI, and total score of SAQLI had significantly improved at the 30^th day after nursing education intervention. As a whole, quality of life index was getting improved trend with a gradual increase in the intervention time, especially the 7^thday after the intervention to improve the most.

Therefore, it is recommended in OSA patients using CPAP therapy during 1-7 days continued to a month with follow up the care, which is very necessary care and critical moment. For the necessary, there is to set staffing of CPAP case managers, who provide one by one individual health education, provide education with handout, closely follow up, and provide counseling of nursing education. There is providing the nursing education before CPAP therapy and within a week as soon as possible to promote the use of CPAP compliance and improve the quality of life of OSA patients. The results of the study could be provided as a reference on clinical care map for the future in OSA patients with CPAP therapy.