Management of obstructive sleep apnoea in a primary care vs sleep unit setting: a randomised controlled trial

Abstract

Results; >>NCT02234765, Clinical Trials.gov.

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

“…The model includes training of reference health-care professionals from primary care and validation of simple screening tools that allow the family physician to select the patients who can be managed in the primary care setting (mild–moderate OSAHS) from those who have to be referred to sleep units to start specific treatment. The study differs from other interesting recent clinical trials 22–24 in that it may be applicable to the entire phenotypic spectrum of patients, because inclusion is not restricted to a certain “a priori” clinical probability of OSAHS, which accounts for only 30% of the total OSAHS population. 26,27 On the other hand, the 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.…”

“…19,20 Different models of integral management of patients with high clinical probability of OSAHS in the primary care setting have been proposed, with non-inferior mid-term results to those reported in sleep units. 21–24 However, although these results open new perspectives in management of OSAHS, the feasibility of the implementation of these models in clinical practice has been questioned. Among other limitations, it has been argued that primary care physicians have to assume a central role in the care of patients with OSAHS, which simplifies excessively the management of patients with an increasingly complex disease.…”

Managements for Obstructive Sleep Apnea in Adults: Review

“…CPAP is one of the most effective therapies used in OSA that opens the airway by delivering the airway through the tube and prevents air collapse during sleep. Positive airway pressure therapy is highly efficacious in reducing car accidents, improving the quality of sleep, reducing blood pressure, and preventing cardiovascular disease development due to OSA [ 24 ]. In a meta-analysis of 35 trials, CPAP showed positive results in the apnea-hypopnea index (AHI) mean difference -33.8 events in an hour.…”

“…We ran a total of four different trials using the meta-analysis (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Choosing the right device is as important as adherence to the daily usage of CPAP.…”

Can primary care providers manage obstructive sleep apnea?

“…5 Researchers in Australia and Spain have consistently shown in 4 recently published, randomized controlled trials that outcomes for patients with OSA who are managed by primary care physicians and nurses in primary care are comparable to those managed in specialist settings, and with significant cost savings. [6][7][8][9] It could be argued that these trials involved a limited number of interested and highly motivated primary care providers (PCPs), so questions remain unanswered as to whether PCPs more generally are willing and ready to assume greater responsibility for OSA diagnosis and care and whether patients would be in favor of management models for sleep disorders that are centered within primary care.…”