Date of Conferral



Doctor of Nursing Practice (DNP)




Mattie Burton


Obstructive sleep apnea (OSA) is a sleep-related disorder that pauses or decreases air flow during sleep as a result of an obstructed upper airway. About 25 million people in the United States are affected by OSA. OSA has low identification and referral rates, especially in primary care facilities as indicated by the lack of patients' sleep histories. Screening tools such as questionnaires ensure an effective detection of OSA. The practice-focused question examined whether implementing the Epworth sleepiness scale (ESS) in an outpatient primary care setting would increase the number of referrals of high-risk patients. The purpose of the project was to improve the referral rates of high-risk patients for OSA evaluation through ESS in a primary care clinic. The plan-do-study-act model was used to guide and evaluate the intervention and analysis of outcomes to determine the success and failure rates of the intervention in relation to the project goal. The data were collected from an outpatient primary care clinic. Measures of central tendency were used to summarize the data, and a 2-proportion z test was employed to analyze the efficiency of the education procedure. The findings showed that the implementation of the ESS increased the number of referrals for high-risk patients (z = 4.140, p = 0.000), indicating that the ESS is an effective tool in facilitating the management of OSA. The findings of this project could be used to increase awareness of the positive benefits of the ESS, which can encourage the implementation of the tool in other clinical facilities and further education about the ESS. The project might contribute to positive social change and nursing practice through the increase of referrals for OSA, which improves the quality of life of patients.