Effectiveness of an Educational Strategy Focused on Obstructive Sleep Apnea

  

    
Session
    
Topic
    
Key    points
  
  

    
1
    
Introduction and diagnostic evaluation
    
Introduction and generalities: obesity and    metabolism, the good eating dish
  
  

    
2
    
Nutrition in OSA
    
General points of good nutrition, changing lifestyles,    introduction to food groups
  
  

    
3
    
Lipids in diet
    
Lipids in foods, types of lipids, food label reading
  
  

    
4
    
Relapse management
    
Food relapse management, define and identify    relapses
  
  

    
5
    
Family support in OSA
    
Learn healthy eating habits and the importance of family    support
  
  

    
6
    
Physical activity in OSA
    
Know the benefits of physical activity and exercises
  
  

    
7
    
Type of physical activity in OSA
    
Learn to perform physical activity safely, types of    physical activity, muscle strengthening exercises
  
  

    
8
    
Support networks and final evaluation
    
Identify support networks and final evaluation of    the strategy
  

Table 1: Educational intervention sessions.

Materials and Methods

An educational intervention study before and after was carried out in the Family Medicine Unit #32, of the Instituto Mexicano del Seguro Social (IMSS), located in Nuevo Leon, Mexico; in patients which were selected by a consecutive sampling techniques; that met the following inclusion criteria: any age, with OSA, any sex, that accepted and signed an informed consent; patients with neurological diseases were not included and eliminated those who did not complete the educational intervention or those with incomplete information.

The following data was obtained directly from the patients or medical records: age, sex, marital status, occupation, comorbidities, alcoholism, smoking, use of hypnotics, anatomical airway alterations, cervical perimeter, abdominal perimeter, nutritional status, apnea index, excessive daytime sleepiness and adherence to CPAP. The procedure for the data collection was as follows: age was calculated in years according to the year of birth; sex was determined by the phenotype characteristics of each individual; marital status was expressed by each patient; occupation, alcoholism and smoking were determined by asking directly to patients; comorbidities, anatomical airway alterations and use of hypnotics were recollected from medical records; nutritional status, cervical and abdominal perimeter were measured with a Braunker weighing machine model YP200CBMI and a Hergom tape measure; the apnea index and adherence to CPAP was evaluated with the monthly report of each patient and excessive daytime sleepiness was determined with the Epworth test which classifies patients into three categories, normal sleep (1-6 points), medium somnolence (7-8 points) and abnormal somnolence (9 or more). The educational intervention was divided into eight sessions (Table 1), with small groups, each session lasted 60-90 minutes once per week.

The recollected data was integrated into data collection sheets and analyzed using the EPI-INFO program version 7, where we applied descriptive statistics; for qualitative variables, frequencies and percentages were used and for quantitative variables, mean and standard deviation were used. For the bivariate analysis, the Wilcoxon test was used to determinate statistically significant differences between the groups before and after the educational intervention. The Kolmogorov-Smirnoff test was used to establish the normality of the data. It was considered a p<0.05 as statistically significant, with a 95% confidence interval. The Protocol was authorized by the Local Committee of Research and Ethics in Health Research from the Family Medicine Unit #32, with registration number R-2019-1909-028.

Results

We analyzed a sample of 119 patients, of whom 36 (30%) were women and 83 (70%) men. The mean age was 58.2 ± 12.3 years. According to marital status, 8% were single, 6% free union, 84 were married and 2% widowers. The most frequent occupation was employed (49%). The most frequent comorbidities were the following: diabetes 39% (n= 46), arterial hypertension 60% (n= 71), obesity 48% (n= 57), smoking 21% (n= 25), alcoholism 20% (n= 24), use of hypnotics 21% (n= 25) and metabolic syndrome 11% (n= 13). Anatomical alterations were deviation of nasal septum 11% (n= 13), tonsillar hypertrophy 33% (n= 39) and large uvula 13% (n= 15).

Within the pre-intervention clinical characteristics (Table 1), cervical circumference of low probability was reported in 48% (n= 57), high-risk abdominal circumference in 76% (n= 90) and overweight in 33% (n= 38) of the participants. The grade I apnea/hypopnea index had a frequency of 92% (n= 108) and grade II with 9% (n= 11). In the Epworth index, 88% obtained a score classified as normal (n = 105), in the adherence to CPAP, a correct use (100%) was reported in 60% (n= 71) of the patients. In the post-intervention clinical characteristics (table 1), cervical perimeter of low probability was reported in 55% (n= 66), high-risk abdominal perimeter in 75% (n= 89) and 34% overweight (n= 40). The grade I apnea/hypopnea index had a frequency of 92% (n= 110) and grade II with 8% (n= 9). In the Epworth index, 96% obtained a score classified as normal (n= 114), in the adherence to CPAP, a correct use (100%) was reported in 67% (n= 80) of the patients.

Discussion and Conclusion

The most important finding of the research was an improvement in the clinical variables with the educational intervention. In the present study the scale of excessive daytime sleepiness (Epworth) was used, as well as the apnea/hypopnea index reported by the CPAP. There were a greater number of male participants which is similar to that reported by De la Paz [4]. In Mexico, despite not having exact data on the prevalence of OSA, Guerrero and Hidalgo [7-8] report a higher prevalence in men.

  

    
 
    
Pre-intervention
    
Post-Intervention
    
 
  
  

    
Variable
    
n
    
%
    
n
    
%
    
p
  
  

    
Cervical perimeter
    
 
  
  

    
Low probability
    
57
    
48%
    
66
    
55%
    
 
  
  

    
Moderate    probability
    
41
    
34%
    
40
    
34%
    
>0.05
  
  

    
High    probability
    
21
    
18%
    
13
    
11%
    
 
  
  

    
Abdominal    perimeter
    
 
  
  

    
Low    risk
    
7
    
6%
    
10
    
8%
    
 
  
  

    
Moderate    risk
    
22
    
18%
    
20
    
17%
    
>0.05
  
  

    
High    risk
    
90
    
76%
    
89
    
75%
    
 
  
  

    
Body    mass index
    
 
  
  

    
Normal
    
30
    
26%
    
34
    
29%
    
 
  
  

    
Overweight
    
38
    
33%
    
40
    
34%
    
 
  
  

    
Obesity    grade 1
    
25
    
22%
    
28
    
24%
    
>0.05
  
  

    
Obesity    grade 2
    
13
    
11%
    
7
    
6%
    
 
  
  

    
Obesity    grade 3
    
9
    
8%
    
8
    
7%
    
 
  
  

    
Apnea    index
    
 
  
  

    
Grade    I
    
108
    
92%
    
110
    
92%
    
 
      
>0.05
  
  

    
Grade    II
    
10
    
8%
    
9
    
8%
  
  

    
CPAP (100% use)
    
 
    
 
    
 
    
 
    
 
  
  

    
Yes
    
71
    
60%
    
80
    
67%
    
 
      
<0.05
  
  

    
No
    
48
    
40%
    
39
    
33%
  
  

    
Epworth    scale
    
 
  
  

    
Normal
    
105
    
88%
    
114
    
96%
    
 
  
  

    
Marginal    somnolence
    
7
    
6%
    
4
    
3%
    
<0.05
  
  

    
Excessive    somnolence
    
7
    
6%
    
1
    
1%
    
 
  

Table 2: Baseline characteristic of patients before and after intervention.