Management Setting of Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is associated with cognitive impairment, daytime sleepiness, and cardiovascular and cerebrovascular morbidity and mortality. Continuous positive airway pressure (CPAP) remains the primary treatment for this disorder, and recent data provide novel insight regarding optimal CPAP application and compliance. Promising alternate forms of OSA treatment have also been addressed with recent clinical research.

Sleep Medicine Board Certification Status of Physicians and American Academy of Sleep Medicine Sleep Center Accreditation Improves Healthcare Outcomes in Obstructive Sleep Apnea Patients Treated with Positive Pressure Therapy. It's Not Complicated!

“…Therefore, the study of Chai-Coetzer was likely underpowered to demonstrate a difference in the PAP adherence metric. Additionally, as noted by Weingarten and Basner, 8 study withdrawal was 2-3 fold higher in primary care versus specialist groups, with nearly half of the withdrawals in the primary care group due to PAP intolerance. Demonstrating non-inferior reduction in subjective sleepiness as determined by ESS in OSA in a tightly controlled protocol managed by primary care physicians and allied health providers relative to sleep specialist should not be interpreted as providing equivalent PAP adherence and cardiovascular risk reduction.…”

“…6 The investigators conducted a comparison of within-trial sleep diagnostic and treatment cost and report a total average cost per randomized patient of $1819.44 in the primary care group and $3067.86 in the sleep specialist group. Although the investigation has signifi cant limitations 7,8 that make the conclusions diffi cult to extrapolate to the general population and to healthcare systems outside of Australia, the data nonetheless question the value of specialty care in the diagnosis and management of OSA. It appears that what was once not so complicated is, in fact, now complicated and controversial.…”

“…It appears that what was once not so complicated is, in fact, now complicated and controversial. [7][8][9] In this issue of the Journal of Clinical Sleep Medicine, Parthasarathy and colleagues 10 deploy a multicenter prospective comparative effectiveness approach to assess the effect of sleep medicine board certifi cation of physicians and AASM accreditation of sleep centers on selected patient centered clinical outcomes in a cohort of 502 subjects with OSA diagnosed by polysomnography conducted in the United States. The primary end point for analysis was objectively derived adherence to positive airway pressure (PAP) therapy.…”