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Should the diagnosis and management of OSA move into general practice?

Monique Suárez, Jeisson Osorio, Marta Torres, Josep M. Montserrat
Breathe 2016 12: 243-247; DOI: 10.1183/20734735.011216
Monique Suárez
1Unitat del Son. Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
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  • For correspondence: mcsuarez@clinic.ub.es
Jeisson Osorio
1Unitat del Son. Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
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Marta Torres
1Unitat del Son. Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
2CIBER de Enfermedades Respiratorias, Madrid, Spain
3IDIBAPS, Barcelona, Spain
5Both authors contributed equally
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Josep M. Montserrat
1Unitat del Son. Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
2CIBER de Enfermedades Respiratorias, Madrid, Spain
3IDIBAPS, Barcelona, Spain
4Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
5Both authors contributed equally
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    Figure 1

    Management of OSA: a) past, b) present and c) future (personalised medicine). SAHS: sleep apnoea–hypopnoea syndrome; RP: respiratory polygraphy. #: high pre-test patients without comorbidities are eligible for primary care management. Reproduced from [19] with permission from the publisher.

Tables

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    Comparative effectiveness studies between primary care management of OSA versus traditional sleep unit management

    First author [ref.]Study typeSubjects nPC/SU nStudy populationStudy protocolPrimary and secondary outcomes
    Antic [31]Randomised controlled, noninferiority, multicentre195100/95Referred with a clinical suspicion of OSA with overnight oximetry oxygen saturation dip rate 2%, ODI >27From three separate academic sleep medicine services in AustraliaRandomised into PC led by sleep trained nurse with four nights home auto-titration CPAP or laboratory physician-directed care with full laboratory PSG and PSG CPAP titrationBoth had follow up visits at 1–3 monthsPC management was noninferior to laboratory management on improvements of ESS scores at 3 monthsNo differences between groups on FOSQ, SF-36, CPAP adherence, patient satisfaction, Executive maze performanceCost-effectiveness: PC was A$1 111.00 less than traditional
    Andreu [33]Randomised prospective6522/22/21Referred with high clinical suspicion of OSA, based on ESS >12 and a Sleep Apnea Clinical Score >15Hospital Sant Joan d’Alacant, SpainRandomised into three groups: a) home study and nurse management; b) PSG and sleep unit management by pulmonologist; or c) home study and sleep unit managementVisits at 1, 3 and 6 monthsPatients with a high initial probability of OSA can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home respiratory polygraphy/hospital follow-up
    Chai-Coetzer [30]Randomised controlled, noninferiority15581/74PC consultation for any reason with a high pretest questionnaire, overnight home oxymetry (3% ODI >16) and ESS >8 or 2 or more antihypertensive
    Three rural regions or hospital sleep centre in Australia
    Randomised into PC management by PC physicians and nurses: 3 days auto-titrating CPAP or hospital management by sleep specialist with or without PSG or slit night followed by PSG CPAP titrationPC: nurse phone call week 2 after CPAP, and 1, 3 and 6 months visitsHospital visits at 1, 3 and 6 monthsImprovement in ESS scores at 6 months with PC management was noninferior to sleep unit managementNo difference between groups on FOSQ, SASQ, SF-36, CPAP adherence, blood pressure and weightCost-effectiveness: PC US $ 1819.44 versus hospital $3067.86
    Sánchez-de-la-Torre [32]Randomised controlled, noninferiority210101/109OSA diagnosed by PSG or respiratory polygraphy in hospital with AHI >30, ESS >10 and or high cardiovascular risk; and required CPAP, titrated with auto-CPAPHospital sleep unit and eight PC units in SpainRandomised into: PC management by a PC physician and nurse (1, 3 and 6 months visits and calls if necessary) or sleep unit management by specialist nurse (same schedule) and specialist consultation if necessaryPC did not result in worse 6 months CPAP compliance compared with a specialist modelCost-effectiveness: PC €144 versus sleep unit €356
    • PC: primary care; SU: sleep unit; ODI: oxygen desaturation index; AHI: apnoea–hypopnoea index; SF-36: Short Form 36 Health Survey; SASQ: Sleep Apnea Symptom Questionnaire.

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Should the diagnosis and management of OSA move into general practice?
Monique Suárez, Jeisson Osorio, Marta Torres, Josep M. Montserrat
Breathe Sep 2016, 12 (3) 243-247; DOI: 10.1183/20734735.011216

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Should the diagnosis and management of OSA move into general practice?
Monique Suárez, Jeisson Osorio, Marta Torres, Josep M. Montserrat
Breathe Sep 2016, 12 (3) 243-247; DOI: 10.1183/20734735.011216
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  • Article
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    • Management, screening and assessment for OSA needs to be a priority in primary care settings
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