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Introduction The merger of two similar hospitals but with very different sleep pathways allowed a comparison, particularly of the use of Clinical Nurse Specialists (CNS) on one of the sites.Methods A retrospective study was conducted on patients set up on CPAP on the two sites, sampled from August to December 2018. Data were collected on time from referral to CPAP set up, severity, patient outcomes, and approximate staff costs of the variable parts of the pathways. A total of 132 episodes were investigated.Results All patients on the consultant led site saw a consultant at least once, but none of the sampled patients on the CNS led site required a consultant appointment. This resulted in significant differences in set up costs between the two sites. The use of CNS significantly reduced waiting times by expanding the number of new appointments available. Compliance hours and change in Epworth score were comparable between the two sites. The number of patient visits on the consultant led site was higher than the CNS led site.Interestingly severity was significantly higher on the CNS site, however a number of patients on the consultant site were given CPAP on the basis of an essentially normal oximetry, but with compelling symptoms which may explain at least part of this difference. Mean CPAP pressure used was significantly lower on the CNS site, which predominantly relied on fixed pressure machines, however as the compliance hours and change in Epworth sleepiness scale were not significantly different, this does not suggest undertreatment in this group. BMI was not different in the two patient groups, and thus does not explain the differences seen in severity or CPAP pressure.Conclusions CNS led sleep clinics increase capacity and reduce costs compared to consultant led ones, without negatively impacting patient outcomes (table 1).Abstract P24 Table 1Mean (unless otherwise stated) figures comparing the patients, their outcomes (at approximately 3 months), and the staff costs of the two pathways