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Less costly, more accessible and as effective: Simplified treatment for sleep apnea
Date:3/5/2009

r diagnosis and subsequent treatment could be simplified without health costs to the patient, Dr. Antic and colleagues developed a nurse-led diagnosis and treatment model that featured ambulatory overnight oximetry and auto-titrating CPAP machines to set fixed CPAP under nurse supervision. They compared the results of patients thus diagnosed and treated to those who underwent standard sleep medicine pathways, including laboratory-based polysomnography, CPAP titration and physician management of the patient.

They assessed the patients' sleepiness on the validated Epworth Sleepiness Scale (ESS) and set the minimal clinically significant change at +/- 2 points. They also assessed other outcomes of sleep, including quality of life measures, executive neurocognitive function on maze tasks and maintenance of wakefulness tests and CPAP adherence. In all, the study assessed almost 200 patients with moderate to severe OSA who were randomly assigned to the simplified or traditional model.

The patients in the nurse-led group spent about 50 minutes longer with the nurse than the patients in the physician-led groups, but were seen by physicians 12 percent of the time. Patients in the physician-led group, meanwhile, had an average of 2.36 consultations with physicians, as opposed to 0.18 for patients in the nurse-led group.

Despite these obvious differences, none of the secondary outcomes measured showed significant differences between the groups, and differences in ESS scores between groups were lower than the pre-determined minimum for clinical significance.

Notably, the patients in the nurse-led group were diagnosed and treated for $722 U.S. dollars less per patient than those in the physician-led group, but did not suffer from inferior care or outcomes.

"While we were not surprised at this finding, we were very pleased, as it indicates a robust new avenue for providing better access to sleep services for those with moderate-sever
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Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

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