A Cost-effective Nurse-Led Programme using Brief Motivational Enhancement Education and Early Follow-Up to enhance Continuous Positive Airway Pressure Adherence in Subjects with Obstructive Sleep Apnea

Abstract

Introduction : Evidence-based practice has long been a guiding principle of clinical care. Poor adherence to continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea (OSA) affects the effectiveness of this therapy. Early nurse-led education and follow-up can enhance CPAP initiation and adherence. Objectives : The current longitudinal study aimed to examine the feasibility and effectiveness of an early theory-based nurse-led clinic using a brief motivational enhancement education and follow-up programme (ME) (Lai AYK et al. Chest 2014, awarded Excellent Research Award 2017) to enhance CPAP initiation and adherence in subjects with obstructive sleep apnea in real-world clinical practice. Methodology : From January 2017 to December 2018, subjects with OSA who were prescribed CPAP treatment and received an early nurse-led ME at the sleep disorder centre at Queen Mary Hospital were included in the longitudinal survey. The CPAP initiation (started to use CPAP) and adherence rates (at 3 months) were compared with before implementation of the early nurse-led ME, the advice and clinical follow-up were conducted by medical officers. The early nurse-led ME was grounded on a social cognitive theory and employed a brief motivational interviewing style. The ME comprised a 25-minute educational video before titration and a 20-minute patient-centered face-to-face interview in the morning after CPAP titration, as well as a 10-minute phone call at 1 month after titration. The ME aimed to enhance the knowledge, risk perception, realistic outcome expectation, self-efficacy, intention and practice on CPAP use. CPAP usage data was downloaded at the nurse clinic follow-up. Result & Outcome : 398 subjects with obstructive sleep apnea [mean±SD: age 55±12 years, Epworth Sleepiness Scale score 9±5, CPAP pressure 11±3 H2O cm, and median (interquartile range), apnea hypopnea index of 35 (22, 52) events/hour] were included in the survey. After the implementation of the early nurse-led ME, more than 90% subjects stated that they planned (64%) or considered (27%) using CPAP. At 3 months, 66% of subjects were using CPAP, with 64% of these subjects being adherent users (>70% of days with >4 hours per day). This was an improvement compared with before implementation of the early nurse-led ME, at which point only 41% of subjects used CPAP; of these, 61% were adherent users. Our findings show that an early nurse-led theory-based education and follow-up that is a feasible and cost-effective approach to enhance CPAP initiation and adherence in subjects with OSA in real-world clinical practice.