Better health outcomes for OSA using the Flinders Chronic Disease Management Program
Antic, NA, Garner S, Harris M, Heatley E, McEvoy RD, Battersby M
Introduction: Obstructive Sleep Apnea (OSA) is a chronic disease with long term complications. OSA is a disease more prevalent in men and seen in higher prevalence amongst Veteran populations. Medical management of OSA includes CPAP to maintain airway patency. An additional program targeting factors contributing to OSA, comorbidities and lifestyle factors, including weight loss as a goal, could reduce excessive daytime sleepiness and improve other health outcomes. The intent of this pilot project was to evaluate the feasibility and acceptability of using the Flinders Program to target risk factors, as well as manage chronic disease in patients with OSA
Methods: Adelaide Institute for Sleep Health Physicians recruited patients with moderate to severe OSA (AHI≥30)
between 09/2010 and 11/2010. At the initial appointment they were asked to complete baseline questionnaires
(demographics, HADS, ESS, PACIC) and then they commenced the Flinders program with a trained clinician:
this included jointly creating a care plan and identifying and setting goals with the intention of improving tenacity and motivation with OSA therapies as well as other problems and comorbidities. Referrals were provided to a commercial meal replacement program and health resources as required. Contact was maintained by a clinician to support behaviour change and participants attended two additional appointments at six weeks and four months later.
Results:Eleven patients agreed to participate and nine patients completed the study. At Baseline: mean weight
116.0 kg (SD 33.1); mean BMI 39 (SD 8.2); mean waist circumference 126 cm (SD 18.7); mean ESS 8.5 (SD 4.6);
mean HADS Anxiety 7.5 (SD 2.8) and Depression 5.5 (SD 3.2); mean PACIC 2.44 (SD 0.77). At the 4 month follow up the average weight change was -8.8 kg (SD 8.8) with an average change of 3 in BMI (SD 2.2). Patients also reported being less sleepy with an average change of -2.9 points (SD 4.1) in ESS and more satisfied with their chronic illness care with an average increase of 1.4 (SD 0.7) measured by PACIC. Their scores for depression and anxiety also improved (HADS Anxiety -3.1 SD 3.6, Depression -4.2 SD 3.9).
Conclusions: Most patients completed the program and there were notable improvements in weight, sleepiness and satisfaction with chronic disease care. The pilot project showed the Flinders Program to be a feasible and acceptable program to target risk factors as well as lead to better health outcomes in OSA
Funding: Part funded by Foundation Daw Park