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Introduction A sleep nurse clinician was added to our care team to provide situationally responsive educational, behavioral and troubleshooting interventions and case management to patients identified as high risk for untreated SDB. The objective of this study was to describe the patient characteristics, nursing interventions, and impact on CPAP usage among patients referred to the nurse-clinician. Methods Descriptive exploratory retrospective chart review was used to identify patient characteristics for all new patients referred; in-depth extraction was conducted for patients who had home CPAP for ≥ 1 month and experienced difficulty using CPAP. We examined: issues using CPAP, frequency and types of nursing contacts, nursing interventions and CPAP usage. Patient characteristics of those with difficulty adapting to CPAP were compared to those referred for assistance to obtain CPAP. Change in objective CPAP usage before vs after sleep nurse case management was determined when possible. Results 403 patients were referred, with mean (SD) age: 54.8 y (15.7), 56.1% men, RDI: 45.4 (31.4), 42.4% employed, 16.6% retired, 25% with ≥ 3 co-morbidities plus SDB. Difficulty adapting group (n = 204) had more women (p = 0.033), more employed (p = 0.03), and more insomnia (p = 0.001). CPAP issues included: mask (18%), ENT (14%), constraining beliefs (14%), access to treatment (12%), pressure intolerance (11%), comorbidities (11%), suboptimal usage (7%), insomnia (7%). Nursing contact: 74% subjects had ≤ 4 contacts (range: 1–16), 53% in-person, 25% telephone calls, 22% other. Nursing interventions were: educational (33%), troubleshooting (30%), behavioural (20%), liaison/coordination of care (13%), promoting self-management skills (3%). Preliminary mean CPAP usage (n = 18) improved by 40.0 (112.3) min and by 7.4 (31) % of nights used ≥ 4 hrs (p=NS; data extraction ongoing). Conclusion Demographic data identified women and insomnia to be significant characteristics in the difficulty adapting group. This model of care identified 2 types of interventions not previously recognized in typical interventions to promote CPAP adaptation: Liaison/coordination of care and promoting self-management skills. Some patients were able to increase their CPAP usage. Support (if any) MUHC Nursing Research Small Grants Award was supported by the Newton Foundation and the Montreal General Hospital Foundation.

Background: Parkinson’s disease (PD) is the second most frequent neurodegenerative disease and is associated with cognitive dysfunction. Obstructive sleep apnea (OSA) has been linked with cognitive dysfunction in the general population and in PD. Treatment with positive airway pressure (PAP), can improve cognition in the general population and in patients with other neurodegenerative diseases. However, the effect of PAP therapy on cognitive function has not been well studied in PD.Methods: This randomized controlled trial will assess the effect of 6 months of PAP therapy versus placebo on global cognitive function in PD patients with OSA and reduced baseline cognition. Secondary outcomes will include quality of life and other non-motor symptoms of PD. Exploratory outcomes will be specific domains of neurocognitive function and symptoms of REM sleep behaviour disorder.Conclusions: PD-related cognitive dysfunction often evolves towards dementia and has substantial personal, social and healthcare costs. Few interventions have been shown to improve cognition in PD to date. If positive, results from our study could prove OSA to be a new therapeutic target relevant to cognition and would support more systematic screening for OSA in PD patients with cognitive decline.Trial Registration: Trial registration number is NCT02209363.