## 6 Role of Nurses in the Follow Up and Support of Obstructive Sleep Apnoea Patients  
Obstructive sleep apnoea treatment and strategies to upscale therapy adherence: The treatment of OSA is often multimodal in nature and involves PAP therapy, behavioural interventions, medical device use, and surgical procedures, depending on the patient symptoms and clinical status. Behavioural interventions include weight loss approaches, exercise and sleep position. These may provide benefits in a proportion of patients, although results of interventions may not be realised immediately [66; 68]. The use of strategies to enhance adherence to PAP therapy and to promote remote management of patients with OSA are gathering interest, including pharmacological therapies, telemedicine approaches to care provision and supplemental oxygen use. [PERSON] et al. [63] found that a telemedicine-based approach to supporting PAP device use in the community was associated with similar outcomes to standard care, including benefits for mental health and functional outcomes of patients. Telemedicine may provide a basis for remote support, with a high level of satisfaction, in the long-term management of OSA, although further studies are needed to build on this pilot study which only lasted three months and included 60 patients [63]. The role of nurses in follow up and support including patient education: In three randomised controlled trials, patient-reported sleepiness and PAP therapy adherence were comparable at 6 months between primary care unit and specialist sleep care unit [38; 41; 42]. For instance, a study was conducted to evaluate whether primary care providers could provide follow-up for patients with OSA undergoing PAP therapy [42]. The patients with OSA were randomly assigned to either the specialised sleep unit or primary care units for follow-up over the course of six months. The primary outcome was adherence with PAP therapy at six months [42]. Additionally, the secondary outcomes were Epworth Sleep Scale (ESS) score, EuroQoL, patient satisfaction, BMI, blood pressure and cost-effectiveness. Based on the results, primary care management of patients with OSA was not associated with poorer outcomes than sleep unit management and was shown to be more cost-effective than sleep unit specialist management. This study involved nurses in the follow-up of patients in the sleep unit, as well as patients undergoing primary care as described below [42]. In the primary care centres that collaborated in this study, one primary care physician and one nurse participated in an educational programme (6 h) that covered both theoretical and practical aspects of managing patients with OSA. The education was delivered by a sleep physician and specialist nurse from the sleep unit who were responsible for managing PAP therapy treatment for the patients in this study who were assigned to the sleep unit group. The patients were followed up in person by a primary care physician or a primary care nurse to review patients' progress, provide support for the PAP device setup, advice regarding managing PAP-related adverse effects and encouragement to comply with PAP therapy and adhere to its use, education and lifestyle modification. Furthermore, the patients were asked to complete relevant research questionnaires. During the course of the study, the patients were followed at 1, 3, and 6 months. Patients could also consult with the primary care physician or nurse who performed the follow-up visits via telephone if necessary. Sleep unit management was performed by the sleep unit specialist nurse in a similar manner to the way it was previously performed by the primary care nurse [42]. Follow up of child/paediatric patients with OSA: This review identified only one study regarding the management of paediatric OSA [61]. The purpose of the study was to determine the effectiveness and satisfaction of a nurse-led phone follow-up service in children following surgery for sleep disordered breathing SDB or OSA in a tertiary paediatric hospital.