Figures
- 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
- Table 1
Comparative effectiveness studies between primary care management of OSA versus traditional sleep unit management
First author [ref.] Study type Subjects n PC/SU n Study population Study protocol Primary and secondary outcomes Antic [31] Randomised controlled, noninferiority, multicentre 195 100/95 Referred with a clinical suspicion of OSA with overnight oximetry oxygen saturation dip rate 2%, ODI >27From three separate academic sleep medicine services in Australia Randomised 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 months PC 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 prospective 65 22/22/21 Referred with high clinical suspicion of OSA, based on ESS >12 and a Sleep Apnea Clinical Score >15Hospital Sant Joan d’Alacant, Spain Randomised 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 months Patients 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, noninferiority 155 81/74 PC 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 AustraliaRandomised 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 months Improvement 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, noninferiority 210 101/109 OSA 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 Spain Randomised 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 necessary PC 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.
Vol 12 Issue 3
Table of Contents
Should the diagnosis and management of OSA move into general practice?
