Date of Award
5-10-2026
Degree Type
Evidence-Based Project Report
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
First Advisor
Mackenzie Shireman
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Spence, Paige, "A Quality Improvement Project to Increase Identification and Treatment of Obstructive Sleep Apnea in Patients With Type 2 Diabetes in a Rural Clinic" (2026). Evidence-Based Practice Project Reports. 222.
https://scholar.valpo.edu/ebpr/222
Included in
Community Health and Preventive Medicine Commons, Family Practice Nursing Commons, Geriatric Nursing Commons, Nursing Administration Commons, Nutritional and Metabolic Diseases Commons, Public Health and Community Nursing Commons, Quality Improvement Commons, Rural Health Commons
Comments
Obstructive sleep apnea (OSA) is a prevalent yet frequently underdiagnosed chronic condition among adults with type 2 diabetes mellitus (T2DM), affecting approximately 50–70% of this population and contributing to poor glycemic control, increased cardiovascular risk, and reduced quality of life (Pivetta et al., 2021; Zheng et al., 2022). In rural primary care settings, barriers such as limited screening practices, reduced specialty access, and symptom-based identification often delay diagnosis and treatment. This Doctor of Nursing Practice (DNP) quality improvement project was implemented in a rural Indiana primary care clinic serving 651 adults with T2DM, where only 36 patients had a documented OSA diagnosis prior to implementation. The purpose of this project was to evaluate whether routine OSA screening using the STOP-BANG questionnaire and Epworth Sleepiness Scale (ESS), compared to symptom-based screening alone, would improve early identification and management of OSA in adults with T2DM over a three-month period. Existing evidence from systematic reviews, clinical guidelines, and diagnostic studies supports the use of STOP-BANG and ESS as reliable tools for identifying high-risk patients and improving early intervention outcomes (Bernhardt et al., 2022; Kapur et al., 2017; Feltner et al., 2022). The practice change integrated paper-based STOP-BANG and ESS screening into routine diabetic visits for eligible adults. Patients with STOP-BANG scores of three or greater were referred for home sleep apnea testing (HSAT), with confirmed cases guided toward continuous positive airway pressure (CPAP) therapy. Clinical outcomes demonstrated improved screening consistency, with 90.9% of eligible patients screened and 63.6% identified with previously undiagnosed OSA. Among those diagnosed, 42.9% initiated CPAP therapy, demonstrating improved detection but ongoing barriers to treatment adherence. Preliminary findings demonstrated improved workflow integration and greater awareness of OSA risk within diabetic care, though barriers such as transportation, insurance limitations, and treatment adherence impacted follow-through. Routine OSA screening in rural primary care was feasible and supported earlier recognition of OSA among adults with T2DM. Project success was driven by staff education, evidence-based workflow integration, and provider engagement, while lessons learned emphasized the importance of resource accessibility and long-term follow-up.