1

Sleep Health

Sleep Health:
A program to increase the number of people with Heart Disease, Diabetes and Hypertension
that are evaluated for risk of Obstructive Sleep Apnea.
Sharon Trongaard BS, RRT
Health 634
Liberty University
October 16, 2015

Sleep Health

Title of Project
Sleep Health: A program to increase the number of people with Heart Disease, Diabetes and
Hypertension that are evaluated for risk of Obstructive Sleep Apnea.
Author
Sharon Trongaard BS, RRT & Clinical Sleep Educator
Need Statement
Sleep is just as important to our health and well being as proper diet and physical activity1 but
little focus has been placed on the crucial role sleep plays in our physical and mental wellbeing
by the medical community. Objective SH-1 from Health People 2020 is Increase the
proportion of persons with Obstructive Sleep Apnea who seek medical evaluation.1 One piece
of reaching this goal lies with Primary Care, Family Practitioners and Internal Medicine
physicians who treat patient with chronic conditions and need to be educated to evaluate patients
for OSA. The remaining piece lies with educating patients themselves and encouraging them to
be their own advocate to seek evaluation of their sleep.
Goals
1. By the end of the program, 60% of people with Hypertension, Diabetes and/or Heart Disease
in the North Texas Area will understand their increased risk for Obstructive Sleep Apnea as
measured by results from surveys.
a. 300 attendees at the Dont Ignore the Snore seminars within the first year
b. 75% of Attendees at Dont Ignore the Snore seminars indicate through exit surveys
that they have a better understanding of the impact of OSA on chronic diseases and
understand their risk level.
2. By the end of the program 35% of people with Hypertension, Diabetes and/or Heart Disease
will have completed the OSA Screening Questionnaire.
a. 2,000 website visitors within the first year that spend a minimum of 5 minutes on the
site and visit more than one page
b. 25% of physician offices utilizing simple screening forms to determine OSA risk in
patients during the first year of the program.
3. By the end of the program 25% of people with Hypertension, Diabetes and/or Heart Disease
in the North Texas Area will have shared the results of the Screening Questionnaire with
their physician or completed the screening at the physicians office.
a. 50% of website visitors indicating through short electronic surveys that the
information contained on the website helped motivate them to discuss sleep apnea
with their physician during the first year of the program.
b. 25% of physician offices utilizing simple screening forms to determine OSA risk in
patients within the first year of the program.
Sponsoring Agency
HOST Sleep Testing of America, LLC
1720 Kansas Ave
Kansas City, MO 64127
www.hostsleeptesting.com
Contact Person:
Sharon Trongaard BS, RRT

Sleep Health
CEO & Clinical Sleep Specialist
p. 888-694-7658
f. 888-694-4655
Primary Target Audience
The Sleep Health program is focused on reaching people that have already been diagnosed with
Heart Disease, Diabetes and Hypertension, diseases that are highly associated with Obstructive
Sleep Apnea.2,3,4 Although all of these chronic disease are serious, the patient priority listed
below is based upon increased risk of mortality and morbidity from untreated sleep apnea in
these populations.
1. Patients with Heart Disease especially those who have had Coronary Artery Bypass
Surgery, Cardiac Catheterization, Angioplasty, or an Acute Myocardial Infarction.
2. Patients with Diabetes especially those on injectable insulin, taking more than one oral
medication to control blood glucose levels or medication resistant glucose control.
3. Patient with Hypertension especially those who are on more than one medication for
blood pressure control.
Primary Target Key Strategies
Audience
Action
Barriers
Heart
Communicate Fear of
Disease
increased risk Treatment with
Patients
of OSA
CPAP, costs,
testing at sleep
lab

Benefits
Lessen risk of
sudden
cardiac death,
future MI

Credibility
Respiratory
Therapist
Clinical
Sleep
Educator
AASA

Diabetic
Patients

Communicate
increased risk
of OSA

Fear of
Treatment with
CPAP, costs,
testing at sleep
lab

Decreased
need for
medications
to control
blood glucose

Respiratory
Therapist
Clinical
Sleep
Educator
AASA

Hypertension Communicate
Patients
increased risk
of OSA

Fear of
Treatment with
CPAP, costs,
testing at sleep
lab

Decreased
need for
medications
to control
hypertension

Respiratory
Therapist
Clinical
Sleep
Educator
AASA

Channel
Mass Media
Radio
Organizational &
Community
seminars
Mass Media
Internet
Print - Brochures

Mass Media
Radio
Organizational &
Community
seminars
Mass Media
Internet
Print - Brochures
Mass Media
Radio
Organizational &
Community
seminars
Mass Media
Internet
Print - Brochures

Sleep Health

Secondary Target Audience

Sleep Health also endeavors to increase the awareness by physicians that their patient
populations may be at high risk for OSA and to encourage the use of screening questionnaires
and assessments that inquire about a patients sleep health. Our primary physician audience will
be endocrinologists, cardiologists and Internal Medicine physicians who are most likely to
manage patients with diabetes, heart disease and hypertension. Priority for physician specialties
will be based upon the morbidity and mortality associated with the patient populations they care
for 1) Cardiologists, 2) Endocrinologists and 3) Internal Medicine.
Primary Key Strategies

Cardiologists

Audience

Action
Communicate
increased risk
of OSA in
their specific
patient
population

Barriers
Unfamiliarity
with OSA
diagnosis and
treatment, lack
of time and
resources

Benefits
Lessen risk
of sudden
cardiac
death, future
MI

Credibility
Respiratory
Therapist Clinical
Sleep Educator
Joint Commission
Accredited

Channel
Printed
Brochures and
screening
tools
Interpersonal
office visits

CMS Enrolled

Internal Medicine

Endocrinologists

American College
of Cardiologists
Communicate
increased risk
of OSA in
their specific
patient
population

Unfamiliarity
with OSA
diagnosis and
treatment, lack
of time and
resources

Decreased
need for
medications
to control
blood
glucose

Respiratory
Therapist Clinical
Sleep Educator

Joint Commission
Accredited

Printed
Brochures and
screening
tools
Interpersonal
office visits

CMS Enrolled
Communicate
increased risk
of OSA in
their specific
patient
population

Unfamiliarity
with OSA
diagnosis and
treatment, lack
of time and
resources

Decreased
need for
medications
to control
hypertension

Respiratory
Therapist Clinical
Sleep Educator

Joint Commission
Accredited

CMS Enrolled

Printed
Brochures and
screening
tools
Interpersonal
office visits

Sleep Health
Pretest Strategy

Patient Brochures were tested with a small group of patients and providers. Radio ads were
pretested with the general public and medical professionals for content and clarity. Internet
website was pilot tested with specified patient groups and feedback given online. The Dont
Ignore the Snore seminar will be pretested with two groups of patients in different settings prior
to the presentation being finalized along with presenter notes.
Theoretical Foundation
The Health Belief Model has been utilized while developing and implementing the Sleep Health
program given its strength in producing lifestyle and behavior change that needs to extend over
time. The process of recognizing, diagnosing and treating Obstructive Sleep Apnea is
considerable. People with Hypertension, Heart Disease and Diabetes will need to be convinced
by the Sleep Health program that 1) they are at risk (perceived susceptibility), that there are
serious consequences (perceived severity), that treatments are effective (perceived benefits), that
negative health effects of inaction outweigh any reason to avoid screening and testing (perceived
barriers) and that snoring and daytime sleepiness can be life-threatening (cue to action).
Messages in the program are consistent, but the delivery (print, radio, interpersonal and
community/organizational) will layer the message to reinforce learning and acclimation.
Leadership
The Leadership Team of Sleep Health includes a Director, Clinical Sleep Educators and
Marketing Specialist. Although the Director is ultimately responsible for budget, operations,
strategic planning and regulatory issues, the tasks associated with program development and
implementation are spread among the team. Refer to Appendix 1 Gantt Chart Sleep Health.

Director
Marketing
Specialist
Clinical
Educator

Clinical
Educator

Clinical
Educator

Budget & Justification

Initial and sustaining grants through the ASAA and the North Texas Health Foundation have
provided funding for the initial and subsequent 2 years of operations including advertising. The
website, educational seminars and physicians educational materials, as well as radio advertising
are covered in their entirety by this funding. Patients and physicians will need to invest only
their time and interest in learning about OSA and their options for diagnosis and treatment.

Sleep Health

Projected salary dollars are commensurate with education level of the candidates and current
market analysis for 5 FTEs. After the initial year adjustments may be made based on volume of
patients/seminars/visits and continued or declining grant funding. Benefits were figured at 25%
of salary budget, which is in line with North Texas market area. Rent, utilities, office supplies,
and computers reflect shared space and shared workstations. Advertising budget was previously
outlined in detail in the marketing plan and reflects actual quotes for services.
Resource
Salaries
Benefits
Rent
Utilities
Office Supplies
Computer/Electronics
Advertising
Radio Ad Development
Radio Spots (24 total)
Print Materials (brochures,
handouts)
Website Development
Yearly Maintenance
Total

Sleep Health Initial Year Budget

Amount
235,000
58,750
6,600
2,400
1,200
3,500

Total
235,000
58,750
6,600
2,400
1,200
3,500

2,000
700
7,500

2,000
16,800
7,500

1,500
245

1,500
245
335,495

Concerns/Potential Problems
There are several concerns/issues that could create barriers to Sleep Health having the impact
necessary to increase people with Heart Disease, Diabetes and Hypertension from seeking
evaluation of their risk of OSA. The primary factor would be the program strategies being
ineffective at eliciting a response from the target audiences to take action. In order for the
program to have the highest chance of inspiring patients and physicians to action it will be based
on best practice principles used to educate patients, develop website and print publications and
evaluate the program. A secondary factor could be the program not having the reach within the
North Texas Area through the multi-faceted advertising campaign. Thirdly, significant support
from physicians is required to make this program successful. This type of support is generally
obtained through the development of personal relationships and a level of trust within the
physician community. Being a fairly new organization, developing that trust in a short period of
time will be challenging.
Evaluation Strategy
The Sleep Health intervention will be using both a Formative (in the form of a Process
Evaluation) and Summative evaluation (in the form of an Impact Evaluation) to verify the
effectiveness of the program both during development and after the interventions. The primary
questions would be 1) how many people within our target audience are we reaching, 2) are we
increasing the knowledge and recognition of the symptoms of sleep apnea and 3) is the

Sleep Health

knowledge influencing the participants to seek testing? Each component of the program will
have specific evaluation tools in place.
1. Website - Monitoring quantitative website analytics by monitoring reach (overall number
of individuals using the site), penetration (share of the target audience) and engagement
(intensity of the visitors interaction) will be a key factor in evaluating the effectiveness of
this tool.
2. Educational Seminars Dont Ignore the Snore will utilize exit interviews t determine
knowledge increase and recognition of sleep apnea symptoms.
3. Telephone and personal interviews with physicians will help determine the number of
patients being evaluated for sleep apnea risk.
REFERENCES:
1. Health People 2020. Objectives: Sleep Health
http://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health. Last Updated
September 1, 2015.Accessed September 3, 2015.
2. Drager L F, Togeiro S., Polotsky V Y, et al. (2013). Obstructive sleep apnea. Journal of
the American College of Cardiology, 62(7), 569-576.
3. Calhoun D. Obstructive Sleep Apnea and Hypertension. Curr Hypertens Rep.
2010;12(3):189-195.
4. Pallayova M, Lazurova I, Donic V. Hypoxic damage to pancreatic beta cells The
hidden link between sleep apnea and diabetes. Medical Hypotheses. 2011;77(5):930-934.

Sleep Health

Appendix 1