P053 Implementing rehabilitation-led management of obstructive sleep apnoea in a spinal cord injury rehabilitation centre: results of a mixed-methods evaluation

Abstract Introduction Obstructive sleep apnoea (OSA) is the most common sleep disorder in spinal cord injury (SCI), yet it is under-diagnosed and under-treated. A SCI rehabilitation centre in Sydney adapted and implemented an alternative rehabilitation-led model of managing OSA. The aim of this project was to evaluate the feasibility of this care model. Methods The model was implemented in July 2022 and piloted for 12 months. The mixed-methods evaluation included analysis of clinical data to assess reach and effectiveness, and qualitative interviews with staff and patients to explore acceptability and barriers and enablers to implementation. Results 48 inpatients were screened; 24 were assessed for OSA, 12 were diagnosed and recommended treatment, six were treated with continuous positive airway pressure (CPAP), and four were discharged with CPAP. Staff reported improvements to their knowledge, skills, and confidence in managing sleep and respiratory issues, and significant benefits to patient care. Coordinating assessments was initially challenging and additional nursing time was allocated to support this. Staff experienced significant barriers to initiating CPAP, including limited opportunities for skill development, high staff turnover, and high workload pressures. Local respiratory physician support with diagnosis and treatment plans was essential. Conclusions This is the first time an Australian SCI rehabilitation centre has implemented a rehabilitation-led OSA management model. Assessing and diagnosing OSA was feasible. For CPAP initiation to be feasible, additional staff time and training would be required. This care model could substantially improve access to OSA treatments for people living with SCI.