Doctoral Dissertations

Date of Award

8-2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Lora Beebe PhD, PMHNP-BC, FAAN

Committee Members

Helen Baghdoyan PhD, Katherine Newnam PhD, NNP-BC, CPNP, IBCLE, Marian Roman PhD, RN

Abstract

Obstructive sleep apnea (OSA) is a condition affecting an estimated 22% of men and 17% of women. Individuals with OSA have periodic bouts of apneas and hypopneas while sleeping that negatively impacts their sleep quality and neurohormonal function. As a result, individuals with OSA are at increased risk for diseases including diabetes, cancer, stroke, myocardial infarction, and depression. Continuous positive airway pressure (CPAP) therapy is an effective treatment for but adherence rates are low at an estimated 60%.The purpose of this pilot study was to examine the effects of a four-week text message-based intervention on an individual's CPAP device adherence, OSA symptom management, and outcome expectations when compared to participants receiving generic text messages. Participants were randomized to an experimental group (EG) (n=29) or to a control group (CG) (n=28). The EG received one motivational text message every week for four weeks based on concepts derived from the theory of planned behavior (TPB). The CG received one text message every week for four weeks with objective information (average use in hours per week). Total mask-on time and CPAP adherence status were measured using CPAP device real-time data. Symptom management and CPAP use expectations were evaluated using Apnea Belief Scale (ABS), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10).There was no significant difference in total mask-on time between the two groups (p=.64). The proportion of participants classified as adherent did not differ between the two groups (p=.17). Differences in ABS, ESS, and FOSQ-10 scores between groups were also not significant (ANOVA, ABS: p =.47; ESS: p =.81; FOSQ: p =0.97).The pilot study identified trends toward improved CPAP adherence with use of TPB-based text messages. For example, the experimental group’s adherence rate was 14.8% higher than control group’s adherence rate. The lack of significance in the 3 instruments may have occurred because they measured actual behavior (CPAP use) and not what effect the intervention had on changing the behavior. More research is needed to elucidate the impact of TPB-based text messages on improving CPAP adherence and outcomes for individuals with OSA.

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