A Randomized Controlled Trial of Nurse-led Care for Symptomatic Moderate–Severe Obstructive Sleep Apnea

Abstract

A simplified nurse-led model of care has demonstrated noninferior results to physician-directed care in the management of symptomatic moderate-severe OSA, while being less costly. Clinical trial registered with http://www.anzctr.org.au (ACTRN012605000064606).

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

“…[83][84][85][107][108][109][110] Four of these RCTs were determined to be most relevant to clinical practice, as they did not require oximetry testing as a criterion for inclusion and used conventional methods for determination of PAP pressures (i.e., APAP or attended titration). [83][84][85]110 This subset of studies will be referred to as "RCTs most generalizable to clinical practice" for the remainder of this discussion section.…”

“…[83][84][85][107][108][109][110] The meta-analysis showed a clinically and statistically insignificant difference of 0.38 points (95% CI: −1.07 to 0.32 points) greater improvement in patients randomized to the HSAT pathway versus the attended PSG pathway. This difference indicates that subjective sleepiness is similarly improved in patients who initiate PAP treatment based on diagnosis using either HSAT or PSG.…”

“…84,85,[107][108][109][110] Meta-analysis demonstrated differences in pooled effects between pathways that were not significant (see supplemental material, Figure S19 through Figure S23, and Table S58). The quality of evidence ranged from moderate to high based on the measure used to assess QOL.…”

“…[83][84][85][108][109][110] When determining adherence by number of nights with greater than 4 hours of use, meta-analysis of five RCTs found a clinically insignificant trend towards increased CPAP adherence in the HSAT arm versus the PSG arm (see supplemental material, Figure S25). [83][84][85]107,110 The quality of evidence for CPAP adherence was moderate to high across different AHI cutoffs after being downgraded due to imprecision.…”

Sleep Disorders in Aboriginal and Torres Strait Islander People and Residents of Regional and Remote Australia

“…6 A report by the Sleep Health Foundation estimated the prevalence of OSA in Australia in 2010 was 4.7% or approximately 750,000 Australians. 1 A recent Australian community cohort study reported an OSA (AHI ≥ 10) prevalence of 53% in males age 40 y or older, and a moderate (AHI [20][21][22][23][24][25][26][27][28][29] to severe (AHI ≥ 30) OSA prevalence of 26%. 7 Comparable studies of indigenous peoples from New Zealand 8 and Canada 9 reported a Māori OSA prevalence of 14% (RDI ≥ 5), 11% (RDI ≥ 10) and 6% (RDI ≥ 15), and American Indian OSA prevalence of 33% (AHI [5][6][7][8][9][10][11][12][13][14] and 23% (AHI ≥ 15).…”