Implementing rehabilitation-led management of obstructive sleep apnoea in a spinal cord injury rehabilitation centre: a mixed-methods evaluation

The aim of this study was to evaluate the feasibility of an alternative, rehabilitation-led model for managing obstructive sleep apnoea (OSA) in an Australian spinal cord injury (SCI) inpatient rehabilitation centre. The mixed-methods evaluation included quantitative analysis of clinical data and qualitative interviews with staff and patients to assess reach, effectiveness, adoption, acceptability, implementation, and sustainability (RE-AIM framework) of the OSA care model. During the 12-month pilot, 48 inpatients were screened, 24 were assessed for OSA, 12 were diagnosed and recommended treatment, 6 commenced continuous positive airway pressure (CPAP) therapy, and 4 were discharged on CPAP. No adverse events were recorded. Clinical staff reported significant benefits to patient care and improved knowledge about sleep and respiratory issues. Insufficient staff time and skills resulted in significant barriers to initiating treatment with CPAP. This is the first time an Australian SCI rehabilitation centre has implemented a rehabilitation-led OSA care model. Assessing and diagnosing OSA in the inpatient unit was feasible and sustainable but initiating treatment required additional staffing and ongoing training. Scaled implementation of rehabilitation-led OSA care could significantly improve access to OSA treatments and quality of life for people living with SCI.Implications for rehabilitationObstructive sleep apnoea (OSA) is the most common sleep disorder in spinal cord injury (SCI); yet it is under-diagnosed and under-treated.To improve access to care, an Australian SCI inpatient rehabilitation centre adapted and implemented an alternative, rehabilitation-led model of managing OSA.The alternative care model was safe, acceptable to staff and patients, and improved access to OSA assessments and treatments.Rehabilitation-led management of non-complicated OSA has the potential to improve outcomes for people living with SCI.To be sustainable, the rehabilitation-led care model should be adequately staffed with ongoing staff training opportunities available. Obstructive sleep apnoea (OSA) is the most common sleep disorder in spinal cord injury (SCI); yet it is under-diagnosed and under-treated. To improve access to care, an Australian SCI inpatient rehabilitation centre adapted and implemented an alternative, rehabilitation-led model of managing OSA. The alternative care model was safe, acceptable to staff and patients, and improved access to OSA assessments and treatments. Rehabilitation-led management of non-complicated OSA has the potential to improve outcomes for people living with SCI. To be sustainable, the rehabilitation-led care model should be adequately staffed with ongoing staff training opportunities available.