3 years ago

Nurse versus physician-led care for obstructive sleep apnea: A systematic review and meta-analysis of randomised trials

Qiuyi Ouyang, Gang Niu, Dianye Yao, Xiaojun Chen, Ping Wang, Yaoye Wu, Fengqiu Gong, Lihong Xie
Aim To evaluate the effectiveness of nurse-led care for obstructive sleep apnoea compared with physician-led care. Background The incidence of obstructive sleep apnoea is increasing worldwide. There is a need for cost-effective care models to ease off the pressure on tertiary care centres and divert care to the community. Design Systematic review and meta-analysis. Data sources We searched major electronic databases (MEDLINE, EMBASE, AMED, British Nursing Index, CINAHL, HMIC, PsycINFO, Health Business Elite and the Cochrane Central Register of Controlled Trials CENTRAL) from inception till December 2016 using a structured search strategy for all randomised trials evaluating nurse-led treatment interventions for adults with obstructive sleep apnoea compared with physician-led ones. We screened relevant articles against a predefined inclusion criteria. We applied no search limitations. Review methods We assessed the risk of bias as per Cochrane recommendations. We calculated Weighted Mean Difference with 95% confidence intervals for continuous outcomes and used a random-effects model to meta-analyse data. Results We screened 309 articles and only four studies met our inclusion criteria. All studies used continuous-positive airway pressure as the main treatment strategy with similar compliance rate in both comparison groups. The scores of the Epworth Sleepiness Scale, the SF-36 questionnaires for vitality, physical function and the SF-36 mental health were all similar between the two groups. There was a significant heterogeneity in all meta-analyses (I2 >92%). Conclusion Nurse-led care for adults with obstructive sleep apnoea is non-inferior to physician-led care. More research is needed to standardise nurse-led interventions and evaluate their long-term effectiveness and cost-effectiveness. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/jan.13346

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