Nurse vs. physician-led care for obstructive sleep apnoea: A systematic review and meta-analysis of randomized trials.

Abstract

To evaluate the effectiveness of nurse-led care for obstructive sleep apnoea compared with physician-led care. 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. Systematic review and meta-analysis. 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 randomized 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 criterion. We applied no search limitations. 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. 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%). Nurse-led care for adults with obstructive sleep apnoea is non-inferior to physician-led care. More research is needed to standardize nurse-led interventions and evaluate their long-term effectiveness and cost-effectiveness.