## 9 Discussion
The nursing profession is capable of administering these questionnaires effectively in hospital/sleep unit settings as well as in the primary care settings; they can supervise patients while they self-administer the questionnaires. In accordance with [PERSON] et al. (2015), nurses and physicians are the most appropriate healthcare professionals to evaluate a patient's sleep history, refer the patient to a sleeping unit specialist, and initiate treatment, if needed [80]. However, [PERSON] et al., argue that screening tools/questionnaires will not be of significant benefit in improving disease prediction when primary care professionals are provided with adequate training/education to identify important clinical risk factors for OSA [81]. Nevertheless, the questionnaires may provide useful input in identifying individuals who are suffering from OSA until nursing educational programmes are further developed to integrate OSA as a chronic disease into primary care. According to the current review, there has been a shift away from specialised sleep units and interventions to a primary care management model. This in in line with a previous study that found the primary care model to be comparable to the sleep unit model in terms of patient-reported sleepiness and PAP therapy adherence at six months; the primary care providers were responsible for performing OSA counselling and therapy decisions [82]. As one example, a randomised, controlled, noninferiority study conducted between September 2008 and June 2010 in Adelaide, Australia included individuals with obstructive sleep apnoea who were treated in primary care practices or at a university hospital sleep medicine centre [82]. Regarding primary care management, the patients were overseen by primary care physicians and nurses who attended a 6-h education programme on obstructive sleep apnoea. The patients were reviewed by a nurse in person to evaluate their progress. They were provided advice regarding managing adverse effects associated with PAP therapy, encouraged to adhere to therapy and advised to discuss alternative treatment options with their primary care physician, if necessary. The patients were educated regarding lifestyle changes that could improve obstructive sleep apnoea, and asked to complete relevant research questionnaires [82]. As the transition from specialist sleep unit care to primary care advances in OSA management and follow-up, nurses will be increasingly involved in the management of these patients [83]. In order for patients to benefit from this transition, nurses must be supported and trained in OSA management and follow-up. The evidence base that underlies nurse-led interventions should also be improved. Moreover, there is a need to coordinate specialist and primary care services regarding OSA, so that the role of primary care nurses can be contextualised within the multidisciplinary model of OSA management [84]. The use of PAP therapy for OSA continues to be a standard of care, which can be delivered in a community setting. However, it is important to ensure that adherence to CPAP is optimised in this setting so that the treatment is effective [85]. It has been demonstrated in this literature that nurse-led follow-up, patient education, and telemedicine and e-health approaches may be helpful in increasing PAP therapy adherence. The application of these strategies may promote evidence-based nursing care in the community and may reduce the need for specialist services and treatment escalation, even as there continues to be debate over effectiveness of e-health tools on PAP therapy adherence [86; 87; 88]. The American Academy of Sleep Medicine Task Force on sleep medicine supports telemedicine and e-health but emphasises the need for a clear understanding of its application and maintaining clinical standards of care that encompass all aspects of diagnosis and treatment [89]. This review supports the findings of other studies published prior to 2015. There were three trials comparing nurse-led management with sleep unit specialist management [90; 91; 92].