0517 Management Of Sleep Apnea Patients By A Clinical Nurse: A Randomized Open-label Non-inferiority study.
Bibliographic record
Abstract
Obstructive sleep apnea (OSA) is a prevalent disease and references for the evaluation of patients with suspected OSA often exceeds the sleep clinic’s evaluation capacity thus creating important delays in patients’ care. We performed a randomized open-label non-inferiority study. Patients who were referred to our sleep clinic and had a cardiopulmonary report suggestive of OSA (apnea-hypopnea index greater than 20 events per hour) were randomized to a nursed based or a physician based initial evaluation. Statistical analyses are available for the outcomes at 3 months. The primary endpoint, change in Epworth Sleepiness Scale (ESS) and quality of life (Quebec Quality of Life Questionnaire) from baseline and secondary endpoints of treatment adherence, were assessed using ANOVA. 200 patients were randomized; patient characteristics and choice of therapy were similar between groups. Overall 79,5 % were prescribe continuous positive airway pressure (CPAP) therapy, 3% mandibular advancement device (MAD), 6,5 % upper airway surgery, 1% weight reduction, 2 % positional therapy and 8% refused treatment. At 3 months, patients with CPAP therapy in the nursed-based versus physician-based evaluation had comparable parameters (90th percentile pressure 8.7 versus 8.0 cmH2O, p=0.27 and mean pressure (2.0 versus 6.6 cmH2O, p=0.36) and adherence [371 versus 386 min per night (mean difference 14.2 min; p=0.42) and 74.6 versus 81.3 percent of nights with usage exceeding 4 hours, p=0.14]. There was no significant change in the ESS or any of the domains of the Quebec Quality of Life Questionnaire from baseline in both groups at 3 months. We found no difference between a nurse-based and physician-based initial evaluation at the sleep clinic at 3 months. Data at 6 months will likely confirm non-inferiority of this approach. This study was supported by the Sleep Apnea Research and Teaching Fund of the IUCPQ-UL Foundation and the Alphonse L’Espérance Funds.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.012 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".