Coordinated program between primary care and sleep unit for the management of obstructive sleep apnea

Abstract

The purpose of this study is to develop and validate a work model in the primary health-care setting for identifying patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) based on clinical variables and an ambulatory sleep monitoring study. After screening, patients with mild–moderate OSAHS could be managed by primary care physicians, whereas those identified with severe OSAHS would be referred to specialists from sleep units for starting specific treatment. The proposed model does not move the entire health-care process to a generally overburdened primary care level and favors the coordinated work and the necessary flexibility to adapt the model to challenges and perspectives of OSAHS.

A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study

“…This was a prospective, multicenter study with the participation of six primary health care centers and four sleep units from the urban area of Barcelona (Spain). The methodology of the study has been previously described in detail [ 22 ]. The PASHOS project has been approved by the Clinical Research Ethics Committee of the 10 participating centers, and written informed consent was obtained from all patients.…”

“…The PASHOS project (PASHOS is the Spanish acronym of Advanced Platform for Sleep Apnea Assessment) is a multicenter study conceived for the implementation of an inter-level working model, coordinated between primary care and sleep units. Previous development of the PASHOS project included specific training of primary care professionals (physicians and registered nurses), establishment of inter-level network tools [ 22 ] and analysis of primary care and sleep unit agreement in management decisions for OSA patients [ 23 ]. A moderate level of concordance on diagnostic classification between primary care physicians and sleep specialists was found, there was substantial agreement in patients with severe OSA who were candidates for CPAP therapy [ 23 ].…”

Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain

“…At the end of the training period, all participants analyzed 10 simulated patients with OSA of different levels of severity to check their knowledge acquisition. 33 Details of characteristics and analysis of simulated cases were previously reported in the description of the study protocol. 33 This training program was an overall evaluation (not quantified) of 10 simulated patients with OSA of different complexity and severity, including registers with technical errors.…”

“…33 Details of characteristics and analysis of simulated cases were previously reported in the description of the study protocol. 33 This training program was an overall evaluation (not quantified) of 10 simulated patients with OSA of different complexity and severity, including registers with technical errors. The degree of agreement between the different participants (primary health care physicians and sleep specialists) was analyzed, and finally therapeutic decisions for all simulated patients were reviewed in a joint meeting, with an emphasis on those with mild-to-moderate agreement.…”

“…32 The Advanced Platform for Sleep Apnea Syndrome Assessment, known as the PASHOS project, was conceived with a different approach to the problem: the implementation of a network for tasks and coordination between primary care physicians and specialists from sleep units. 33 Based on the work of the project, the current study includes a population of patients selected in primary care consultation, using a randomization program, with low and high clinical probabilities of OSA. In contrast to previous studies, patients with a low pretest clinical probability of OSA were intentionally included based on the hypothesis that a screening program in primary care may be effective for selecting patients with severe OSA who should refer for starting treatment and to appropriately exclude the presence of OSA, thus preventing unnecessary referrals to the sleep unit.…”