Table 1

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.