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

Abstract

Study Objectives: Involvement of primary care teams in the care of patients with OSA is a focus of interest. The study objective was to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists. Methods: This was a prospective multicenter study conducted at primary care and specialized care centers in the urban area of Barcelona, Spain. Men and women aged 18-75 years who visited the participating primary care centers for any reason were recruited. Both primary care physicians and sleep specialists made a diagnostic and therapeutic decision with clinical data and results of a home sleep apnea test. All patients were finally assessed with respiratory polygraphy or polysomnography as a gold-standard test. Results: A total of 229 patients underwent a home sleep apnea test and were evaluated at the primary care centers and the sleep units. Diagnostic agreement using the same tools and excluding indeterminate decisions was 69.8% (Cohen's kappa = 0.64; 95% confidence interval, 0.56-0.72). Agreement for therapeutic decisions (PAP vs conservative treatment) was obtained in 82.5% of patients (Cohen's kappa = 0.62; 95% confidence interval, 0.51-0.73), increasing to 92.5% (Cohen's kappa = 0.49, 95% confidence interval, 0.40-0.58) when indeterminate options were excluded. As compared with the final therapeutic decisions made at the sleep unit with respiratory polygraphy/polysomnography, primary care physicians agreed regarding 83.3% (Cohen's kappa = 0.62; 95% confidence interval, 0.49-0.74) of patients. Conclusions: Primary care professionals may assume an important role in the management of OSA in coordination with sleep centers, identifying patients who require specific treatment and should be referred to specialized care.

Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care

“…However, all participating PCPs had relatively minimal training compared to previous studies in primary care. 13,37 Additionally, their clinical judgement may have improved over the course of the two-year trial, after receiving results from previously recruited patients. This may lead to a difference in the spectrum of patients between the development and validation datasets.…”

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

“…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 ].…”

“…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 ]. However, the overall sensitivity for detecting candidates for CPAP treatment by primary care physicians was only 62.2% [ 23 ].…”

Primary care and sleep unit agreement in management decisions for sleep apnea: a methodological issue to avoid misinterpretation

“…I was interested to read the study by Peñacoba et al 1 in the Journal of Clinical Sleep Medicine. The authors aimed to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists.…”