## 7 Effectiveness of Nursing Led Interventions  
Clarification of the role of the nurse in the diagnosis and management of OSA may be derived from studies evaluating the effectiveness of nurse-led interventions and management approaches.  
Effectiveness of nurse led interventions: studies in Spain have found that patients with OSA treated by primary care physicians and nurses in a primary care setting have similar outcomes to those treated by sleep unit specialists [38; 42]. In a study conducted by the Spanish Sleep Network, PAP therapy adherence was similar between primary care and sleep units, and primary care settings demonstrated consistent overall effectiveness of care. It is noteworthy, however, that patient satisfaction and sleepiness scores were higher in the sleep unit setting [42]. A number of studies have demonstrated the importance of nursing care in specialist and primary care settings [62; 65; 66; 67]. It was found that nurse-led interventions could improve symptoms, mood, quality of life, and compliance with PAP therapy in an evaluation of 80 patients [62].  
A meta-analysis by [PERSON] et al. [67] found that nurse-led interventions were not inferior to physician-led interventions in terms of symptomatic improvement, cost effectiveness, and quality of life. Additionally, it was found that nursing-led interventions, particularly educational strategies, could improve adherence to PAP therapy in particular, highlighting the important role that nurses can play both in specialist and primary care settings to educate patients. An educational and personalised follow-up intervention conducted via telephone after discharge from a sleep unit was found to be efficient, safe, and well received by patients [66]. Nurse-led interventions have been shown to improve adherence to PAP therapy compared with usual care [62]. Furthermore, it has been shown in a systematic review of eight RCTs that education programmes can improve PAP therapy adherence in the community setting, while evidence for other approaches remains limited, including pharmacological interventions [66].  
Among nursing interventions is the provision of patient education that emphasises lifestyle modification strategies such as providing them with advice about improving their diet, reducing consumption of high-calorie foods, maintaining a healthy lifestyle, and increasing their physical activity [62]. Further, it has been suggested that a family member should be included in the education, as this will strengthen the intervention at home [66]. This highlights the value of nurse-led interventions in promoting follow-up, reducing complications, and reducing unnecessary physical follow-up in practice.  
Using a qualitative approach, a study explored the perspectives of patients and providers regarding OSA management in primary care [65].  
The study identified several barriers, including a lack of access to specialists, a lack of knowledge of OSA among primary care providers, and a lack of clarity regarding the roles of providers in OSA management. In this context, it is suggested that the integration of primary care and specialist services as well as improved system navigation may be crucial to improving OSA management. According to the analysis of qualitative responses, nurses can play a significant role in educating, providing information, and providing holistic support to patients [65].