Skip to main content
Download PDF

Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea–hypopnea syndrome

BMC Pulmonary Medicine volume 22, Article number: 352 (2022) Cite this article

Abstract

Background

The proportion of patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) is increasing year by year in China, which has become a major public health problem. Self-management of OSAHS and multiple support from caregivers are key to low hospital admissions and high quality of life for patients with OSAHS. Social support and health literacy are the main promoters of self-management behavior. However, their contributions have not been adequately studied. The purpose of this study is to investigate the level of self-management among patients with OSAHS and its relationship with general demographics, social support, and health literacy.

Methods

A total of 280 patients with OSAHS treated in two Classiii Grade A hospitals in Jinzhou City, Liaoning Province from October 2020 to July 2021 were selected as the study subjects. Patients were investigated by General Characteristics Questionnaire, Social Support Rating Scale (SSRS), Health Literacy Scale for Chronic Patients (HLSCP), and OSAHS Self-management Behavior Questionnaire, and the influencing factors of self-management of patients with OSAHS were analyzed.

Results

The average score of OSAHS self-management was 74.49(SD = 8.06), SSRS and HLSCP scores were positively correlated with total scores of self-management behavior. Furthermore, we found that disease duration, SSRS, and HLSCP scores were the main predictors of self-management behavior (R2 = 0.390, P < 0.001).

Conclusion

This study found that OSAHS patients with a longer duration of disease and higher SSRS or HLSCP scores also had higher levels of self-management. The factors discussed in this study may be helpful in developing individualized interventions in self-management for patients with OSAHS.

Peer Review reports

Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic condition in which the upper airway collapses during sleep causing obstruction, resulting in apnoea, hypoventilation, hypercapnia, and hypoxemia [1]. According to statistics, nearly one billion people worldwide have OSAHS, of which China has the largest number of OSAHS patients in the world, with over 176 million (23.6%) at high risk of OSAHS in the 30–69 age group [2]. The incidence of OSAHS is increasing every year and has become a public problem that endangers human health [3]. Effective self-management behaviors can reduce OSAHS-related risk factors, decrease the occurrence of complications and delay the development of OSAHS [4, 5]. However, low awareness of the importance of self-management and lack of adherence among OSAHS patients has been reported [6]. Therefore, this study needs to identify potential predictors of patient self-management.

Self-management is a health behavior in which individuals continually treat their illness by maintaining and improving their health and reducing the impact of their illness on their social roles, ideology, emotional responses, and relationships [7]. The recurrence of OSAHS is closely related to negative emotional states and bad behavior patterns, leading to unimaginable consequences [8]. Social support as a protective factor has been widely used in the field of chronic diseases and has attracted attention. In addition, relevant studies have proven that a good social support system is conducive to alleviating patients' negative psychological states and has a positive effect on improving patients' self-management [9, 10]. Health literacy, as an important indicator to evaluate an individual's ability to access and apply health information, is important in improving the physical emotional, and psychological well-being of patients [11].

Social support can be obtained from relatives, friends, and social groups, and is an interpersonal resource that can be accessed and used when dealing with life's challenges and stresses [12]. The previous study has shown that social support such as sleep health training for black peers with OSAHS can improve treatment adherence in people with OSAHS [13]. Patients with higher levels of social support are more able to cope with their environment and life changes, and the burden on their primary family carers is relatively less [14]. OSAHS patients with good social support systems can achieve better treatment outcomes and quality of life through long-term progressive self-management behaviors compared to those with poor social support [15].

Health literacy is the ability of an individual to acquire, understand and process the relevant knowledge and information about health services needed for disease and to make sound decisions [11]. A study of functional health literacy in people with OSAHS found that levels of health literacy are important contributors to individuals' participation in health decision-making, coping with complex health systems, and improving the quality of health services [16]. Another study emphasizes that the health knowledge of patients should be considered in the diagnosis and treatment of OSAHS patients [17]. People with high health literacy are more likely to have accurate general knowledge of diseases and to screen and access health information, thus contributing to the self-management of diseases [18].

In summary, social support and health literacy may be strongly associated with self-management behaviors. However, it is unclear whether social support and health literacy lead to better self-management behaviors in OSAHS patients. Therefore, this study aimed to investigate the level of self-management in OSAHS patients and its relationship with socio-demographic factors, social support, and health literacy.

Methods

Participants

This study investigated 280 patients with OSAHS in two hospitals in Jinzhou City, Liaoning Province from October 2020 to July 2021. Patients must meet the following criteria: (1) Patients with an apnea–hypopnea index (AHI) ≥ 5 h and diagnosed with OSAHS by PSG were included in the study; (2) Age ≥ 18 years; (3) No CPAP or surgery; (4) Informed consent and voluntary participation in this study. Exclusion criteria: (1) patients with severe organ dysfunction such as heart, brain, and kidney; (2) patients with severe visual impairment, hearing abnormalities, and other factors that prevent them from completing the questionnaire; (3) patients with cognitive impairment and mental disorders. Before testing, the purpose and significance of the survey are explained in detail to the respondent and informed consent is obtained by signing an informed consent form. The study plan had been approved by the Ethics Committee of Jinzhou Medical University (Ethics Approval Number: LLSC2020008).

Polysomnography

All patients underwent nocturnal polysomnography monitoring and were recorded for more than 7 h. The monitoring program includes multi-channel physiological signals such as EEG, EOG, EMG, pulse oximetry, chest and abdominal airflow movements, and body movements of the subjects. The recorded data were interpreted according to the guidelines of the American Academy of Sleep Medicine (AASM). Sleep apnoea is defined as the absence or significant reduction (≥ 90% from baseline) in nasal and oral airflow during sleep, lasting ≥ 10 s. Hypopnea was defined as a 30% reduction in the airflow for at least 10 s with > 3% oxygen desaturation. The AHI is defined as the average number of obstructive apnoea and hypoventilation events per hour of sleep and is an objective indicator of the severity of OSAHS. According to the AHI, OSAHS can be classified as mild (5 ≤ AHI < 15/h), moderate (15 ≤ AHI < 30/h), and severe (AHI ≥ 30/h).

Instrument

Social support rating scale (SSRS)

Compiled by Xiao [19] in 1986, it includes three dimensions: objective support, subjective support, and utilization of support. Each dimension contains corresponding items: 2, 6 and 7 items, 1, 3–5 and 8–10 items. The scale includes single-choice and multiple-choice items, and the score ranges from 12 to 66. Higher scores indicate that the individual receives, feels, and uses social support to a better degree. The scale is widely used to assess social support in healthy people, chronic diseases, and other research areas. In this study, the overall Cronbach's α scale was 0.730, which has good reliability.

Health literacy scale for chronic patients (HLSCP)

The scale was developed by Jordan JE, Australia, in 2010 to measure and evaluate individual health literacy [20]. Later translated and locally revised by Sun et al. [21] in 2012, it has 24 items in total, covering information acquisition ability, communication interaction ability, health improvement willingness, and economic support willingness. The sum of each item represents an individual's health literacy status. Higher scores indicate higher levels of health literacy. Scores above 96 are considered to have chronic health literacy. The scale has good psychometric indicators, and it is widely used in patients with chronic diseases. In this study, the overall Cronbach's α of the scale was 0.890, which has good reliability.

OSAHS self-management behavior questionnaire

The OSAHS Self-management Behavior Questionnaire was developed by Dong et al. [22] in 2014, which contains four dimensions, namely life management, treatment management, knowledge and skill management, and psychological management, with a total of 21 items. The scores of these 21 items range from 1 to 5, and the sum of each item represents the individual's self-management status, with higher total scores representing higher levels of self-management. Among them, the total score of self-management is divided into three grades: general (total score ≤ 63), medium (total score 63–84), and good (total score ≥ 84). In this study, the overall Cronbach's α of the scale was 0.856, which has good reliability.

Demographic characteristic

General Characteristics Questionnaire included age, sex, living area, education level, marital status, per capita monthly income, disease duration, medical insurance, family history of snoring, and health problem other than OSAHS.

Statistical analysis

SPSS 25.0 statistical software was used for statistical analysis. Measurement data were expressed as mean ± standard deviation (Mean ± SD), and counting data were expressed as (n, %). T-test or one-way ANOVA was used for the mean test and multiple linear regression was used to analyze the influencing factors of self-management, P < 0.05 was considered statistically significant.

Results

Baseline characteristics of OSAHS

Among the 280 OSAHS patients included in this study, 78.6% were male and 21.4% were female. The age distribution of the subjects was mostly 31–50 years old, with an average age of 44.56 ± 9.89. In this study, 94.3% of patients had a spouse. 71.4% of the patients lived in urban areas and 28.6% in rural areas. The educational level of the participants was junior high school (32.5%) and 75.0% of the participants had a monthly income of more than 3,000 RMB (1 RMB = 0.15 USD). Majority of patients with severe OSAHS (47.9%). 72.9% of the patients had medical insurance. 65.0% of the patients had a family history of snoring. There were 156 patients (55.7%) with a disease course of fewer than 5 years and 134 patients (47.9%) with health problem other than OSAHS (Table 1).

Table 1 Sample characteristics (n = 280, %)
Full size table

Factors associated with self-management behavior

Table 2 shows the association between self-management of OSAHS patients and the general demographic characteristics of study participants. General demographic characteristics associated with self-management included living area (t = 2.704, P = 0.007), education level (F = 10.105, P = 0.000), monthly income (F = 13.123, P = 0.000), disease duration (t = − 2.777, P = 0.006), family history of snoring (t = − 2.780, P = 0.006), and health problem other than OSAHS (t = 3.061, P = 0.002).

Table 2 Comparison of self-management level of OSAHS patients with different characteristics (n = 280, Mean ± SD)
Full size table

Correlation between SSRS, HLSCP, and self-management in OSAHS patients

The average scores of SSRS, HLSCP, and self-management behavior of OSAHS patients and their correlation are shown in Table 3. Correlation analysis showed that there was a positive correlation between SSRS and HLSCP (r = 0.350, P < 0.05), SSRS was positively correlated with self-management (r = 0.340, P < 0.05), HLSCP was positively correlated with self-management (r = 0.583, P < 0.05).

Table 3 Correlation between SSRS, HLSCP, and Self-management in OSAHS patients (n = 280, Mean ± SD)
Full size table

Predictors of self-management behavior

To explore the main factors influencing the self-management level of OSAHS patients. The total score of self-management was set as a dependent variable, social support score, health literacy score, and factors with statistical significance in single factor analysis (living area, education level, per capita monthly income, disease duration, family history of snoring, and health problem other than OSAHS) were taken as independent variables. Multiple linear regression analysis showed that the duration of disease, social support, and health literacy had a significant effect on self-management, as shown in Table 4.

Table 4 Multiple linear regression analysis of self-management in OSAHS patients
Full size table

Discussion

This study examines the level of self-management of patients with OSAHS and its relationship with general demographic characteristics, SSRS, and HLSCP. Compared to other chronic diseases, self-management behaviors of OSAHS have been less studied.

Our study found limited self-management in patients with OSAHS, with only 13.9% of patients having a good level of self-management. According to the study [23], over 80% of people at risk of OSAHS are undiagnosed and untreated due to a lack of awareness of OSAHS. The low cognitive level is an important cause of poor self-management behavior in patients [24]. In a study in rural Nepal, practitioner and patient-related factors were also cited as reasons for the limited level of self-management [25]. For example, most physicians focused only on clinical outcomes and neglected the critical role of self-management in improving disease outcomes and quality of life. In addition, many patients feel that the information support provided by health care professionals does not match their wishes, leading to limitations in self-management.

This study found significant differences in the level of self-management among OSAHS patients with different demographic characteristics. The higher level of self-management among OSAHS patients living in cities may be related to easier and more convenient access to medical knowledge and resources for urban residents [26]. The finding that higher educational attainment was associated with better levels of self-management in our study is supported by other research which has identified higher educational attainment as a significant predictor of improved self-management behavior [22, 27]. A study by Tarasiuk et al. found that financial subsidies can lead to more positive treatment intentions and better healthcare experiences in patients with OSAHS, suggesting that financial conditions are an important factor influencing patients' willingness to treat and receive treatment promptly [28]. Patients from well-off families are better able to afford treatment, helping them to better manage their disease and slow its progression. The longer the course of the disease, the higher the level of self-management, which is consistent with the findings in hypertensive patients [29]. However, different from the study on COPD patients, it may be related to individual differences in samples [30]. We found that patients with a family history of snoring had better OSAHS self-care. These findings confirmed that family members play an active role in identifying disease symptoms and monitoring medical behaviors [31]. People with no health problems other than OSAHS have a higher level of self-care. It may be that managing one's health is more difficult when the patient has multiple health problems [32].

This study also found a positive correlation between SSRS, HLSCP, and total self-management scores. No previous studies have been conducted to correlate SSRS, HLSCP, and self-management in OSAHS patients. However, the association between these potential variables has been investigated in other areas of chronic disease. Consistent with our results, Chen et al. [33] studied patients with chronic kidney disease and showed that self-management behaviors were associated with patients' social support as well as health literacy. This was also a consistent finding in a study of patients with heart failure [10]. Early studies have also shown that SSRS [34, 35] and HLSCP [32, 36] are positively associated with self-management behavior, respectively.

Regression analysis showed that disease duration, SSRS, and HLSCP scores were the main predictors of self-management behavior. This is consistent with a study on another chronic disease [33], showing that social support has a positive predictive effect on self-management. The level of social support is thought to influence an individual's internal perceptions, with positive social interactions increasing positive self-perceptions [37]. For example, encouragement and support from partners are important for people with OSAHS to adhere to and implement health management plans (weight loss, smoking cessation, alcohol cessation) [38]. With the valuable advice and substantial help of others, people with OSAHS can receive more information and supervision, which will strengthen their resolve to overcome difficulties and solve problems, helping patients to better manage their disease [39, 40]. In this study, health literacy was also a significant predictor of self-care behavior in patients with OSAHS. Reisi et al. identified that the level of health literacy plays an essential role in the acquisition of disease-related knowledge by individuals and in the use of the knowledge gained to promote and maintain physical health [41]. In addition, when patients acquire a certain level of health knowledge, their self-management will subsequently improve.

The severity of OSAHS is a major contributor to poor quality of life, poor health, and high social costs, so improving the self-management of people with OSAHS is particularly crucial [42]. Studies have confirmed that self-management interventions for people with OSAHS, such as a sensible, regular diet plan and exercise program, can reduce BMI, improve AHI and reduce the risk of disease [43, 44]. The above findings suggest that patients with OSAHS should be aware of the need to actively learn effective disease management practices. In addition, relatives, friends, and social groups around OSAHS patients should provide more support to improve their self-management ability. At the same time, caregivers should be aware that they have a vital role to play in educating patients on the correct use of positive pressure ventilation and ensuring a balance between lifestyle interventions [45]. Furthermore, nursing staff can further strengthen patients' self-management skills and develop effective clinical care pathways based on individual differences to improve the overall health of patients with OSAHS.

This study has some limitations. First, the sample was obtained and selected by a single method, which may lack representativeness. In addition, this study was only conducted in Jinzhou City, Liaoning Province. Therefore, our results should be generalized with caution. Second, because of the self-reported nature of the survey, potential sources of bias are inevitable.

Conclusions and implications

Self-management behaviors play an important role in improving the prognosis and quality of life of patients with OSAHS. This study analyses the impact of general information, social support, and health literacy on the self-management behavior of OSAHS patients. Caregivers can create platforms to help OSAHS patients access, perceive and correctly use social support resources based on relevant predictors. They can also improve the way they communicate with patients, enhance their health literacy and try other interventions to further optimize patients' self-management behaviors.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Qaseem A, Dallas P, Owens DK, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(3):210–20. https://doi.org/10.7326/M12-3187.

    Article  PubMed  Google Scholar 

  2. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–98. https://doi.org/10.1016/S2213-2600(19)30198-5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Patel SR. Obstructive sleep apnea. Ann Intern Med. 2019;171(11):ITC81–96. https://doi.org/10.7326/AITC201912030.

    Article  PubMed  Google Scholar 

  4. Hudgel DW, Patel SR, Ahasic AM, et al. The role of weight management in the treatment of adult obstructive sleep apnea: an official American thoracic society clinical practice guideline. Am J Respir Crit Care Med. 2018;198(6):e70–87. https://doi.org/10.1164/rccm.201807-1326ST.

    Article  PubMed  Google Scholar 

  5. Duan X, Huang J, Zheng M, et al. Association of healthy lifestyle with risk of obstructive sleep apnea: a cross-sectional study. BMC Pulm Med. 2022;22(1):33. https://doi.org/10.1186/s12890-021-01818-7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liu X, Chen J, Zhou J, et al. The relationship between the number of daily health-related behavioral risk factors and sleep health of the elderly in China. Int J Environ Res Public Health. 2019;16(24):4905. https://doi.org/10.3390/ijerph16244905.

    Article  PubMed Central  Google Scholar 

  7. Swerissen H, Belfrage J, Weeks A, et al. A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Educ Couns. 2006;64(1–3):360–8. https://doi.org/10.1016/j.pec.2006.04.003.

    Article  PubMed  Google Scholar 

  8. Garbarino S, Bardwell WA, Guglielmi O, Chiorri C, Bonanni E, Magnavita N. Association of anxiety and depression in obstructive sleep apnea patients: a systematic review and meta-analysis. Behav Sleep Med. 2020;18(1):35–57. https://doi.org/10.1080/15402002.2018.1545649.

    Article  PubMed  Google Scholar 

  9. Costa ALS, Heitkemper MM, Alencar GP, Damiani LP, Silva RMD, Jarrett ME. Social support is a predictor of lower stress and higher quality of life and resilience in brazilian patients with colorectal cancer. Cancer Nurs. 2017;40(5):352–60. https://doi.org/10.1097/NCC.0000000000000388.

    Article  PubMed  Google Scholar 

  10. Jo A, Ji Seo E, Son YJ. The roles of health literacy and social support in improving adherence to self-care behaviours among older adults with heart failure. Nurs Open. 2020;7(6):2039–46. https://doi.org/10.1002/nop2.599.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072–8.

    Article  Google Scholar 

  12. Zhong Y, Wang J, Nicholas S. Social support and depressive symptoms among family caregivers of older people with disabilities in four provinces of urban China: the mediating role of caregiver burden. BMC Geriatr. 2020;20(1):3. https://doi.org/10.1186/s12877-019-1403-9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Seixas AA, Trinh-Shevrin C, Ravenell J, Ogedegbe G, Zizi F, Jean-Louis G. Culturally tailored, peer-based sleep health education and social support to increase obstructive sleep apnea assessment and treatment adherence among a community sample of blacks: study protocol for a randomized controlled trial. Trials. 2018;19(1):519. https://doi.org/10.1186/s13063-018-2835-9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wei W, Yang R, Zhang J, et al. The mediating roles of family resilience and social support in the relationship between illness severity and depressive symptoms among primary caregivers of children with epilepsy in China. Front Neurol. 2022;13: 831899. https://doi.org/10.3389/fneur.2022.831899.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Henry D, Rosenthal L. “Listening for his breath:” the significance of gender and partner reporting on the diagnosis, management, and treatment of obstructive sleep apnea. Soc Sci Med. 2013;79:48–56. https://doi.org/10.1016/j.socscimed.2012.05.021.

    Article  PubMed  Google Scholar 

  16. Li JJ, Appleton SL, Wittert GA, et al. The relationship between functional health literacy and obstructive sleep apnea and its related risk factors and comorbidities in a population cohort of men. Sleep. 2014;37(3):571–8. https://doi.org/10.5665/sleep.3500.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bakker JP, O’Keeffe KM, Neill AM, Campbell AJ. Ethnic disparities in CPAP adherence in New Zealand: effects of socioeconomic status, health literacy and self-efficacy. Sleep. 2011;34(11):1595–603. https://doi.org/10.5665/sleep.1404.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Xu WH, Rothman RL, Li R, et al. Improved self-management skills in Chinese diabetes patients through a comprehensive health literacy strategy: study protocol of a cluster randomized controlled trial. Trials. 2014;15:498. https://doi.org/10.1186/1745-6215-15-498.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shuiyuan X. Theoretical basis and research application of social support Rating Scale. J Clin Psychiatry. 1994;02:98–100.

    Google Scholar 

  20. Jordan JE, Buchbinder R, Osborne RH. Conceptualising health literacy from the patient perspective. Patient Educ Couns. 2010;79(1):36–42. https://doi.org/10.1016/j.pec.2009.10.001.

    Article  PubMed  Google Scholar 

  21. Haolin S, Hui P, Hua F. Study on reliability and validity of health literacy scale for patients with chronic diseases. Fudan J Med Sci. 2012;39(03):268–72.

    Google Scholar 

  22. Dong W. Effect of nursing intervention on self-management and quality of life of patients with obstructive sleep apnea. Xinxiang Medical College; 2014.

    Google Scholar 

  23. Barger LK, Rajaratnam SM, Wang W, et al. Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters. J Clin Sleep Med. 2015;11(3):233–40. https://doi.org/10.5664/jcsm.4534.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sandelowsky H, Krakau I, Modin S, Ställberg B, Nager A. COPD patients need more information about self-management: a cross-sectional study in Swedish primary care. Scand J Prim Health Care. 2019;37(4):459–67. https://doi.org/10.1080/02813432.2019.1684015.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yadav UN, Lloyd J, Hosseinzadeh H, Baral KP, Bhatta N, Harris MF. Self-management practice, associated factors and its relationship with health literacy and patient activation among multi-morbid COPD patients from rural Nepal. BMC Public Health. 2020;20(1):300. https://doi.org/10.1186/s12889-020-8404-7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Allen AJ, Amram O, Tavakoli H, Almeida FR, Hamoda M, Ayas NT. Relationship between travel time from home to a regional sleep apnea clinic in british columbia, canada, and the severity of obstructive sleep. Ann Am Thorac Soc. 2016;13(5):719–23. https://doi.org/10.1513/AnnalsATS.201509-613BC.

    Article  PubMed  Google Scholar 

  27. Tarabzoni O, Samman AM, Hilabi A, et al. The influence of diet, water intake, exercise, education level, and income on the quality of sleep in the saudi population: a cross-sectional study. Cureus. 2022;14(4):e24074. https://doi.org/10.7759/cureus.24074.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tarasiuk A, Reznor G, Greenberg-Dotan S, Reuveni H. Financial incentive increases CPAP acceptance in patients from low socioeconomic background. PLoS ONE. 2012;7(3): e33178. https://doi.org/10.1371/journal.pone.0033178.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Ding W, Li T, Su Q, Yuan M, Lin A. Integrating factors associated with hypertensive patients’ self-management using structural equation modeling: a cross-sectional study in Guangdong. China Patient Prefer Adherence. 2018;12:2169–78. https://doi.org/10.2147/PPA.S180314.

    Article  PubMed  Google Scholar 

  30. Lan X, Lu X, Yi B, Chen X, Jin S. Factors associated with self-management behaviors of patients with chronic obstructive pulmonary disease. Jpn J Nurs Sci. 2022;19(1): e12450. https://doi.org/10.1111/jjns.12450.

    Article  PubMed  Google Scholar 

  31. Zarhin D. Sleep as a gendered family affair: snoring and the “dark side” of relationships. Qual Health Res. 2016;26(14):1888–901. https://doi.org/10.1177/1049732315583270.

    Article  PubMed  Google Scholar 

  32. İlhan N, Telli S, Temel B, Aştı T. Health literacy and diabetes self-care in individuals with type 2 diabetes in Turkey. Prim Care Diabetes. 2021;15(1):74–9. https://doi.org/10.1016/j.pcd.2020.06.009.

    Article  PubMed  Google Scholar 

  33. Chen YC, Chang LC, Liu CY, Ho YF, Weng SC, Tsai TI. The roles of social support and health literacy in self-management among patients with chronic kidney disease. J Nurs Scholarsh. 2018;50(3):265–75. https://doi.org/10.1111/jnu.12377.

    Article  PubMed  Google Scholar 

  34. Zhang D, Zhang N, Chang H, et al. Mediating role of hope between social support and self-management among chinese liver transplant recipients: a multi-center cross-sectional study. Clin Nurs Res. 2022. https://doi.org/10.1177/10547738221078897.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Noviana CM, Zahra AN. Social support and self-management among end-stage renal disease patients undergoing hemodialysis in Indonesia. J Public Health Res. 2021;11(2):2733. https://doi.org/10.4081/jphr.2021.2733.

    Article  PubMed Central  Google Scholar 

  36. Park S, Seo Y. The relationships among health literacy, illness perception, and diabetes self-care in korean-speaking immigrants with diabetes [published online ahead of print, 2022 Mar 20]. Clin Nurs Res. 2022. https://doi.org/10.1177/10547738221082230.

    Article  PubMed  Google Scholar 

  37. Mizutani M, Tashiro J, Sugiarto H, Yulaikhah L, Carbun R. Model development of healthy-lifestyle behaviors for rural Muslim Indonesians with hypertension: a qualitative study. Nurs Health Sci. 2016;18(1):15–22. https://doi.org/10.1111/nhs.12212.

    Article  PubMed  Google Scholar 

  38. Gagnadoux F, Le Vaillant M, Goupil F, et al. Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients. PLoS ONE. 2011;6(8): e22503. https://doi.org/10.1371/journal.pone.0022503.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Salzano G, Maglitto F, Bisogno A, et al. Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients. Acta Otorhinolaryngol Ital. 2021;41(2):120–30. https://doi.org/10.14639/0392-100X-N1100.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bugajski A, Frazier SK, Moser DK, Lennie TA, Chung M. Psychometric testing of the multidimensional scale of perceived social support in patients with comorbid COPD and heart failure. Heart Lung. 2019;48(3):193–7. https://doi.org/10.1016/j.hrtlng.2018.09.014.

    Article  PubMed  Google Scholar 

  41. Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Impact of health literacy, self-efficacy, and outcome expectations on adherence to self-care behaviors in iranians with type 2 diabetes. Oman Med J. 2016;31(1):52–9. https://doi.org/10.5001/omj.2016.10.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Liu Y, Han J, Ning L, et al. Cognitive function and life quality of patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome in China. Expert Rev Respir Med. 2021;15(3):435–40. https://doi.org/10.1080/17476348.2021.1852081.

    Article  PubMed  CAS  Google Scholar 

  43. Thomasouli MA, Brady EM, Davies MJ, et al. The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of randomised controlled trials. Sleep Breath. 2013;17(3):925–35. https://doi.org/10.1007/s11325-013-0806-7.

    Article  PubMed  Google Scholar 

  44. Araghi MH, Chen YF, Jagielski A, et al. Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Sleep. 2013;36(10):1553-1562E. https://doi.org/10.5665/sleep.3056.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Chen X, Chen W, Hu W, Huang K, Huang J, Zhou Y. Nurse-led intensive interventions improve adherence to continuous positive airway pressure therapy and quality of life in obstructive sleep apnea patients. Patient Prefer Adherence. 2015;9:1707–13. https://doi.org/10.2147/PPA.S90846.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank the study participants and hospital administrators for their support in collecting samples.

Funding

This work was supported by the Natural Science Foundation of Liaoning Province (No. 201602297).

Author information

Authors and Affiliations

  1. Department of Nursing, School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, Jinzhou, 121001, China

    Haitao Yu, Ye Gao, Tong Tong, Chunguang Liang, Hui Zhang, Xiangru Yan, Liying Wang & Hongliang Dai

  2. Liaoning Vocational University of Technology, Jinzhou, China

    Ye Gao

  3. The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China

    Huiying Zhang

  4. School of Nursing, Shenyang Medical College School, Shenyang, China

    Huijuan Tong

Authors
  1. Haitao Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ye Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tong Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chunguang Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiangru Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Liying Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Huiying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hongliang Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Huijuan Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HY, TT, and CL were involved in the design of the study. HY, HZ, XY, LW, and HZ helped with data collection. HY, YG, HT, HD, and CL provided statistical suggestions and data analysis. HY was responsible for manuscript preparation and CL for editing and approval. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chunguang Liang.

Ethics declarations

Ethics approval and consent to participate

This study was following the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Jinzhou Medical University (Approval No. LLSC2020008). All study participants received informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, H., Gao, Y., Tong, T. et al. Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea–hypopnea syndrome. BMC Pulm Med 22, 352 (2022). https://doi.org/10.1186/s12890-022-02153-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12890-022-02153-1

Keyword

BMC Pulmonary Medicine

ISSN: 1471-2466

Contact us