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Simpler Apnea Treatment Model Deemed Effective

Nurse-led protocol found not inferior to physician-directed diagnosis and treatment of obstructive sleep apnea

MONDAY, Mar. 9 (HealthDay News) -- A simplified model of diagnosing and treating obstructive sleep apnea can lead to outcomes that aren't inferior to those from in-hospital polysomnograms involving physicians, according to research published in the Mar. 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Nick A. Antic, Ph.D., of the Repatriation General Hospital in Daw Park, South Australia, and colleagues analyzed data from 195 adults who appeared to have moderate-severe obstructive sleep apnea. Subjects were randomized to one of two types of care: a simplified model supervised by a specialist nurse, using home autotitrating continuous positive airway pressure (CPAP); or a model involving two laboratory polysomnograms for diagnosis and treatment, overseen by a physician.

The nurse-led method did not lead to worse change in Epworth Sleepiness Scale score after three months of CPAP treatment than the physician-led method, the investigators found. No differences were seen in CPAP adherence between the groups at three months. The researchers note that costs were lower in the nurse-led model.

"We believe this overall package of care involving simplified obstructive sleep apnea diagnosis, auto-adjusting positive airway pressure titration in the home, and the expansion of the sleep medicine workforce using skilled CPAP nurses working under protocol (with the backup of sleep medicine services if needed) has the potential to add significantly to the field of sleep medicine and improve access to care for those with obstructive sleep apnea," the authors conclude.

Two co-authors disclosed ties to companies, including equipment support from Respironics, ResMed, and Masimo, and research funding or equipment from the Respironics Sleep and Respiratory Foundation, ResMed, and Fisher and Paykel.

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