Date of Award

Spring 5-26-2018

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, DNSc, CRNA

Second Advisor

David Bittleman, MD


Purpose: To reduce cardiovascular risk through optimal obstructive sleep apnea (OSA) management with proactive screening utilizing the Epworth Sleepiness Scale (ESS) in male Veterans with hypertension (HTN) and diabetes mellitus (DM).

Background: OSA is a common finding in primary care, with 1 in 5 adults feeling its effects: excessive sleepiness, impaired cognition, reduced quality of life and increased mortality. Unmanaged OSA has been highly correlated with increased cardiac risk in populations with chronic diseases such as HTN and DM. Fortunately, identification and treatment of OSA has been shown to improve cardiovascular outcomes and reduce mortality. Evidence supports outpatient screening to identify patients at risk for OSA, in order to more effectively manage future cardiovascular risk.

Strategy and Implementation: Analyzing an existing database of 146 outpatient male veterans with HTN and DM, revealed that 52% have an existing OSA diagnosis, while the remainder have not been screened. The Doctor of Nursing Practice (DNP) student will screen these remaining patients for OSA via telephone utilizing the ESS tool. Based on findings, the DNP student will provide evidence-based guidance for further management of OSA to the care team.

Evaluation/Outcomes: Post telephone screening intervention, the DNP student would expect a 40-50% increase in completed OSA screenings by January 2018.

Implications for Practice: Implementing proactive evidence-based OSA screening is the missing link in managing HTN and DM leading to improved cardiovascular outcomes for this Veteran population.