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

• DOI: 10.1164/rccm.200810-1558oc
• Publication Date: 2009-01-09T03:05:32Z
• Authors: Nick A. Antic; Catherine Buchan; Adrian Esterman; Michael Hensley; Matthew T. Naughton; Sharn Rowland; Bernadette Willia...; Samantha Windler; Simon Eckermann; R. Doug McEvoy
• Keywords: Epworth Sleepiness Scale; Positive airway pressure

Rationale: Obstructive sleep apnea (OSA) is a prevalent disease. Often limited clinical resources result in long patient waiting lists. Simpler validated methods of care are needed.Objectives: To demonstrate that nurse-led model can produce health outcomes symptomatic moderate–severe OSA not inferior to physician-led care.Methods: A randomized controlled multicenter noninferiority trial was performed. Of 1,427 potentially eligible patients at 3 centers, 882 consented the trial. these, 263 were excluded on basis criteria. remaining 619, 195 met home oximetry criteria for high-probability and 2 models care: A, simplified model, using autoadjusting positive airway pressure set therapeutic continuous (CPAP), with all supervised by an experienced nurse; B, involving two laboratory polysomnograms diagnose treat OSA, physician. The primary end point change Epworth Sleepiness Scale (ESS) score after months CPAP. Other outcome measures collected.Measurements Main Results: For ESS score, management no worse than (4.02 vs. 4.15; difference, −0.13; 95% confidence interval: −1.52, 1.25) given prespecified margin −2 lower interval. There also differences between both groups CPAP adherence or other measures. Within-trial costs significantly less A.Conclusions: has demonstrated noninferior results physician-directed while being costly.Clinical registered http://www.anzctr.org.au (ACTRN012605000064606)