Evaluation of sleep Apnea Risk and Treatment in Nocturnal Hypertension Study

Diagnosis, treatment and monitoring of obstructive sleep apnea in patients with nocturnal hypertension identified from within primary care, plus usual care for nocturnal hypertension (anti-hypertensive medications and lifestyle advice). The metropolitan GP practices will refer patients for usual OSA care to a specialist sleep centre for sleep study testing, sleep physician review and management. Patient care will involve standard care for patients with suspected OSA, and management decisions will be determined by the treating sleep physician. Usually, this will involve an initial review by a sleep physician, referral for a home or in-laboratory polysomnography, and, if found to have moderate-severe OSA, treatment with lifestyle advice, weight loss and CPAP therapy. Other non-CPAP therapies may also be suggested. The rural GP practices will provide OSA diagnostic testing within their practice using a limited-channel ApneaLink device, OSA management by the GP and CPAP administered by a practice nurse if OSA is confirmed, with sleep specialist advice provided when required. GPs and nurses will be trained on the use of ApneaLink equipment, OSA diagnosis and management. If patients are confirmed as having moderate-severe OSA, patients will be offered CPAP treatment that will be issued to them by the practice nurse. The fixed pressure setting on the CPAP device will be determined following a 1 week auto-CPAP titration study that will be arranged by the practice nurse. Rural GPs/nurses will be supported by specialist sleep services (sleep physicians and nurses), who will provide advice as needed via phone call, emails or teleconference calls, or formal consultation. All patients allocated to the intervention arm will receive in-home health monitoring devices (i.e. an under-mattress sensor mat, smart blood pressure and weight scales) connected via a mobile phone app and Wi-Fi to enable continuous feedback to the patient and their GP during the 4 month follow-up period. Study staff will be able to see if regular data is being collected from the health monitoring devices to assess compliance of recordings, as this data is uploaded to the cloud onto a secure website that is accessible by the research team.