title: Obstructive sleep apnoea syndrome: a nurse-led domiciliary service.
abstract: OBJECTIVE
  This paper reports a successful transformation of clinical practice from inpatient diagnosis and initiation of treatment for obstructive sleep apnoea syndrome to a nurse-led domiciliary model increasing patient access and choice.
  
  
  BACKGROUND
  Obstructive sleep apnoea syndrome is common, affecting globally 2-4% of the adult population. It is characterized by periodic complete or partial collapse of the upper airway, leading to hypoxaemia and sleep fragmentation, resulting in daytime sleepiness and impaired quality of life. It can be treated successfully with nocturnal continuous positive airway pressure. Strategies for diagnosis and initiation of treatment have traditionally been inpatient-based, but limited facilities and increasing demand in many countries have necessitated alternative strategies.
  
  
  METHODS
  As an extension to our current inpatient provision, we have established nurse-led domiciliary investigation and treatment. Patients meeting predefined criteria undergo a limited sleep study followed by therapy initiation at home. Confirmation of investigation findings, evaluation of treatment, education and long-term review are carried out in nurse-led clinics.
  
  
  RESULTS
  We evaluated outcome in the first 150 patients managed in this way between August 2002 and December 2003. In our highly selected patient group, 79% of those who undertook a trial of treatment continued at 3 months, with average compliance >5 hours per night, a figure which compares favourably with our overall patient population. Statistically significant sustained improvement in sleepiness was seen. Independent predictors of long-term acceptability of continuous positive airway pressure were disease severity and magnitude of improvement in sleepiness.
  
  
  CONCLUSIONS
  A nurse-led service for domiciliary diagnosis, treatment initiation and on-going management of selected patients with obstructive sleep apnoea syndrome is feasible and cost-effective, with outcomes comparable with conventional inpatient services. This approach is applicable in most countries where increasing demand for investigations greatly exceeds the availability of traditional facilities.
authors.affiliation: Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK. marktomlinson@lineone.net
authors.forename: Mark
authors.initials: M
authors.lastname: Tomlinson
authors.forename: G
authors.initials: G
authors.lastname: John Gibson
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003152:Community Health Nursing / Q000458:organization & administration / Q000592:standards; D045422:Continuous Positive Airway Pressure; D004739:England; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009731:Nursing Audit; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000451:nursing* / Q000628:therapy; D016896:Treatment Outcome