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Thomas CL, Carr K, Yang F, Fleisher S, Um P, Clemens B, McNutt R, Balkin T, Collen JF. From trenches to technology: a narrative review of sleep medicine in the military. J Clin Sleep Med 2024; 20:973-981. [PMID: 38420974 PMCID: PMC11145036 DOI: 10.5664/jcsm.11088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Diagnoses of military-relevant sleep disorders have increased substantially since the terrorist attacks of September 11, 2001. The cause of this increase appears to be complicated and multifactorial, with military and civilian populations clearly differing with respect to both the nature and distribution of sleep disorders diagnoses. In part, these differences may be attributable to the fact that a majority of service members are chronically sleep-restricted-an unavoidable consequence of continuous and sustained military operations that "set the stage" for development of specific sleep disorders. The purpose of this narrative review is to describe the military relevance of several common sleep disorders, assess the extent to which these disorders currently constitute a burden on the military health care system, and suggest strategies to alleviate that burden. The military health care system does not have enough sleep medicine providers to address the immediate and long-term consequences of sleep disorders in military personnel. Digital technologies and education packages can be leveraged to improve access to care. CITATION Thomas CL, Carr K, Yang F, et al. From trenches to technology: a narrative review of sleep medicine in the military. J Clin Sleep Med. 2024;20(6):973-981.
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Affiliation(s)
- Connie L. Thomas
- Walter Reed Army Institute of Research, Silver Spring, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University, Bethesda, Maryland
| | - Kyle Carr
- Uniformed Services University, Bethesda, Maryland
| | - Felix Yang
- Uniformed Services University, Bethesda, Maryland
| | | | - Paul Um
- Uniformed Services University, Bethesda, Maryland
| | | | - Ryan McNutt
- Womack Army Medical Center, Fort Liberty, North Carolina
| | - Thomas Balkin
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jacob F. Collen
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University, Bethesda, Maryland
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Kaambwa B, Woods TJ, Natsky A, Bulamu N, Mpundu-Kaambwa C, Loffler KA, Sweetman A, Catcheside PG, Reynolds AC, Adams R, Eckert DJ. Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review. PHARMACOECONOMICS 2024; 42:507-526. [PMID: 38340220 PMCID: PMC11039546 DOI: 10.1007/s40273-023-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions. OBJECTIVES This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences. RESULTS Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression. CONCLUSIONS This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Taylor-Jade Woods
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Andrea Natsky
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Norma Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Kelly A Loffler
- Health Data and Clinical Trials, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
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Watach AJ, McPhillips MV, Saconi B, Lang-Gallagher R, Lyons MM, Renz SM, Rosen IM, Sawyer AM. Exploring Nurse Practitioner Students' Perceptions of a Sleep e-Learning Program. Nurs Educ Perspect 2023; 44:229-236. [PMID: 37417857 PMCID: PMC10348450 DOI: 10.1097/01.nep.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
AIM The aim of this study was to explore nurse practitioner (NP) students' perceptions of a sleep e-learning program. BACKGROUND Sleep assessment is uncommon as nursing curricula lack sleep education. By preparing NPs to conduct sleep assessment and screening and understand basic sleep diagnostics, sleep health is more likely to be part of the differential diagnosis. METHOD The study is a qualitative descriptive study utilizing two focus groups. A directed content analysis, guided by the Kirkpatrick model, was used for analysis. RESULTS Twenty-four students participated in focus groups. Two overarching themes emerged: perceptions of course design and content. Asynchronous, case-based scenarios and quizzes were favorable. Students spoke of content relevance to themselves and patients and intentions to adopt sleep assessment practices. CONCLUSION NP students embraced sleep education and declared intention to apply learned skills in practice. This study highlights the feasibility of increasing curricular exposure to sleep education and ensuring NPs have skills to recognize implications of poor and disordered sleep in patients.
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Affiliation(s)
- Alexa J Watach
- About the Authors Alexa J. Watach, PhD, RN, is an instructor, Division of Sleep Medicine, and lecturer, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania. Miranda V. McPhillips, PhD, RN, is a lecturer, School of Nursing, University of Pennsylvania. Bruno Saconi, PhD, RN, is a lecturer, University of Pennsylvania School of Nursing, and staff scientist, Geisinger. Rebecca Lang-Gallagher, MSEd, is research project manager, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine. M. Melanie Lyons, PhD, MSN, ACNP, is an assistant clinical professor and nurse practitioner, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University College of Medicine, Columbus, Ohio. Susan M. Renz, PhD, DNP, RN, is a practice associate professor, University of Pennsylvania School of Nursing. Ilene M. Rosen, MD, MSCE, is an associate professor of medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine. Amy M. Sawyer, PhD, RN, is an associate professor of sleep and health behavior, University of Pennsylvania School of Nursing, and clinician scientist and educator, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania. This work was supported by National Institutes of Health (R25HL120874, Rosen; K23NR018487, McPhillips) and the Agency for Healthcare Research and Quality (AHRQ; K12HS026372, Watach). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government. The authors acknowledge the following for their contributions to the conduct of this research: Kathleen O. DeMutis, DNP, ANP-BC; Hanne S. Harbison, MHSPH, MSN, WHNP-BC; Joe Schatz, DNP, CRNP, PMHNB-BC, CARN-AP; and June A. Treston, DNP, CRNP. For more information, contact Dr. Watach at /
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Gao H, Kan Z, Fang Y, Wang N, Yan W, Yang M, Song Y. Efficacy and safety of acupuncture in the treatment of stroke complicated with sleep apnea syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e33241. [PMID: 37058070 PMCID: PMC10101308 DOI: 10.1097/md.0000000000033241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/13/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND stroke patients often have a combination of sleep apnea syndrome, which is an important and modifiable risk factor for stroke prognosis. Acupuncture is one of the measures for sleep apnea syndrome, and it is also widely used in stroke. However, we are concerned that its efficacy and safety in the treatment of stroke with sleep apnea syndrome are not yet clear. METHODS This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses schema and was registered with INPLASY (registration number: INPLASY202250113). The following 8 databases were searched: PubMed, Cochrane Library (CENTRAL), Embase, Web of Science, China National Knowledge Infrastructure, Chongqing VIP Information, WanFang Data, and China Biomedical Literature Database limited from the establishment of each database to May 4, 2022. Subject headings, free words, and keywords were used for retrieval. Relevant literature was supplemented by consulting other resources. We assessed the risk of bias in the included studies using the Cochrane risk of bias tool. RevMan 5.4 software (The Cochrane Collaboration, 2020) was used to perform the meta-analysis. RESULTS Six records were included, including a total of 513 participants: 256 in the experimental group and 257 in the control group. The results showed that the total effective rate (relative risk = 1.23, 95% confidence interval (CI): 1.13, 1.34, P < .00001), apnea-hypopnea index (mean difference (MD) = -8.39, 95% CI: -9.19, -7.59, P < .00001), Epworth Sleepiness Scale score (MD = -1.59, 95% CI: -2.66, -0.52, P = .004), minimal oxygen saturation (MD = 4.99, 95% CI: 3.5, 6.47, P < .00001), longest duration of apnea (MD = -7.47, 95% CI: -8.97, -5.97, P < .00001), longest duration of apnea (MD = -6.48, 95% CI: -8.60, -4.35, P < .00001), and S100β levels (standard mean difference = -1.52, 95% CI: -1.87, -1.18, P < .00001) were better in the experimental group than in the control group. Simultaneously, the effect of reducing the neuron-specific enolase level in the experimental group was comparable to that in the control group (MD = -3.40, 95% CI: -9.08, 2.29, P = .24). CONCLUSIONS Acupuncture can improve the clinical symptoms and related laboratory indicators for sleep apnea syndrome in patients with stroke. More high-quality trials remain urgently needed.
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Affiliation(s)
- Huanyu Gao
- Institute of Literature and Culture of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zunqi Kan
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuqing Fang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ning Wang
- College of the First Clinical Medical, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wenli Yan
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Mengqi Yang
- College of the First Clinical Medical, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yongmei Song
- Institute of Literature and Culture of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Grivell N, Brown B, Fuller J, Chai-Coetzer CL, McEvoy RD, Hoon E. Barriers and facilitators for the implementation of nurse-delivered chronic disease management within general practice: a mixed methods systematic review protocol. JBI Evid Synth 2023; 21:414-422. [PMID: 36111868 DOI: 10.11124/jbies-22-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to identify the barriers and facilitators for the implementation of nurse-delivered models of care for chronic diseases to inform the development and evaluation of nurse-delivered models of care for chronic sleep disorders. INTRODUCTION Increasing prevalence of sleep disorders and subsequent demand for specialist-led sleep services has prompted investigation into the management of uncomplicated sleep disorders by general practitioners. Models of sleep health care with enhanced roles for general practice nurses have been investigated within the context of randomized controlled trials; however, it is unclear how best to implement these models into clinical practice. With limited research exploring the implementation of nurse-delivered models of sleep health care within general practice, this review will examine the barriers and facilitators for the implementation of nurse-delivered models of care for chronic disease. This will inform the integration of new nurse-delivered models of care for chronic sleep disorders into routine general practice. INCLUSION CRITERIA Studies that report barriers and facilitators for the implementation of nurse-delivered models of care for chronic diseases for adults into a general practice setting will be included. METHODS Six databases will be searched: MEDLINE, CINAHL, Embase, Scopus, Cochrane Library, and Emcare. The search will be limited to qualitative, quantitative, and mixed methods studies. Studies will be included if they contain data that report on barriers and facilitators for implementation of nurse-delivered models of care for chronic diseases. This review will be conducted in accordance with the JBI approach to mixed methods convergent integrated systematic reviews. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021273346.
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Affiliation(s)
- Nicole Grivell
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Brandon Brown
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jeffrey Fuller
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Elizabeth Hoon
- Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
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Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study. J Clin Med 2022; 11:jcm11154449. [PMID: 35956065 PMCID: PMC9369967 DOI: 10.3390/jcm11154449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
West Virginia (WV) has the highest rates of obesity and cardiopulmonary disease in the United States (U.S.). Recent work has identified a significant care gap in WV for obstructive sleep apnea (OSA). This OSA care gap likely has significant health implications for the region given the high rates of obesity and cardiopulmonary disease. The purpose of this mix methods study was to identify barriers that contribute to the rural OSA care disparity previously identified in WV. Methods: This study used mixed methods to evaluate the barriers and facilitators to management of OSA at Federally Qualified Health Centers serving communities in southern WV. Focus groups were conducted at federally qualified health centers with providers serving Appalachian communities. Participants also completed the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire to gain insight into provider knowledge and beliefs regarding OSA. EMR analysis using diagnostic codes was completed at the sites to assess OSA prevalence rates. The same individual served as the interviewer in all focus group sessions to minimize interviewer variability/bias. Our team checked to ensure that the professional transcriptions were correct and matched the audio via spot checks. Results: Themes identified from the focus groups fell into three broad categories: (1) barriers to OSA care delivery, (2) facilitators to OSA care delivery, and (3) community-based care needs to optimize management of OSA in the targeted rural areas. Questionnaire data demonstrated rural providers feel OSA is an important condition to identify but lack confidence to identify and treat OSA. Evaluation of the electronic medical record demonstrates an even larger OSA care gap in these rural communities than previously described. Conclusion: This study found a lack of provider confidence in the ability to diagnose and treat OSA effectively and identified specific themes that limit OSA care in the communities studied. Training directed toward the identified knowledge gaps and on new technologies would likely give rural primary care providers the confidence to take a more active role in OSA diagnosis and management. An integrated model of care that incorporates primary care providers, specialists and effective use of modern technologies will be essential to address the identified OSA care disparities in rural WV and similar communities across the U.S. Community engaged research such as the current study will be essential to the creation of feasible, practical, relevant and culturally competent care pathways for providers serving rural communities with OSA and other respiratory disease to achieve health equity.
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Natsky AN, Vakulin A, Chai-Coetzer CL, McEvoy RD, Adams RJ, Kaambwa B. Preferred Attributes of Care Pathways for Obstructive Sleep Apnoea from the Perspective of Diagnosed Patients and High-Risk Individuals: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:597-607. [PMID: 35141851 PMCID: PMC9206920 DOI: 10.1007/s40258-022-00716-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 06/05/2023]
Abstract
BACKGROUND The current healthcare system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high risk of OSA. OBJECTIVES This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features. METHODS A discrete choice experiment was undertaken in two groups: those with a formal diagnosis of OSA (n = 421) and those undiagnosed but at high risk of having OSA (n = 1033). Participants were recruited from a large cross-sectional survey in Australia. The discrete choice experiment approach used mixed-logit regression models to determine preferences relating to eight salient features of the OSA management pathway, i.e. initial assessment provider, sleep study setting, diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow-up visits. RESULTS The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results and sleep specialists to recommend treatment. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for the initial assessment, sleep study testing and ongoing care provision. CONCLUSIONS The discrete choice experiment results offer a promising approach for systematic incorporation of patient and high-risk group preferences into the future design and delivery of care pathways for OSA management.
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Affiliation(s)
- Andrea N Natsky
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia.
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Billingsley Kaambwa
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
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Pachito DV, Bagattini ÂM, Drager LF, Eckeli AL, Rocha A. Economic evaluation of CPAP therapy for obstructive sleep apnea: a scoping review and evidence map. Sleep Breath 2022; 26:17-30. [PMID: 33788132 DOI: 10.1007/s11325-021-02362-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To synthesize findings of economic evaluations investigating cost-effectiveness of continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) and of strategies of organization of care related to CPAP therapy. METHODS Scoping review with searches conducted in MEDLINE, CRD, LILACS, and Embase in August 2020. Eligible studies were economic evaluations comparing CPAP to other alternative or assessing strategies of care for CPAP therapy. Results were presented narratively, and incremental cost-effectiveness ratios (ICER) were presented in evidence maps. RESULTS Of 34 studies, 3 concluded that CPAP is less costly and more effective when compared to usual care. Most studies indicated that CPAP is associated with better health outcomes, but at higher prices. ICER ranged from USD 316 to 98,793 per quality-adjusted life years (QALY) gained (median 16,499; IQR 8267 to 33,119). One study concluded that CPAP is more costly and less effective, when treatment is applied to all patients, regardless of disease severity. Variability of ICER was mainly due to definition of population and applied time horizons. When CPAP was compared to mandibular advancement device, ICER ranged from USD 21,153 to 361,028 (median 89,671; IQR 26,829 to 295,983), which represents the investment in CPAP therapy required to obtain one extra QALY. Three studies assessed the effects of organizing CPAP therapy in primary care, which was cost-effective or cost-saving. CONCLUSIONS Compared to usual care, CPAP is cost-effective after the second year of treatment, when indicated for moderate-to-severe OSA. CPAP therapy may be even more cost-effective by using different strategies of organization of care. These findings may inform decision making related to CPAP reimbursement in health systems. CLINICAL TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Daniela V Pachito
- Department of Health Technology Assessment, Hospital Sírio-Libanês, Rua Barata Ribeiro 142, São Paulo, 01308-000, Brazil.
| | - Ângela M Bagattini
- Department of Health Technology Assessment, Hospital Sírio-Libanês, Rua Barata Ribeiro 142, São Paulo, 01308-000, Brazil
| | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Alan L Eckeli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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Picard F, Panagiotidou P, Tammen AB, Wolf-Pütz A, Steffen M, Gerhardy HJ, Waßenberg S, Klein RM. Nocturnal blood pressure and nocturnal blood pressure fluctuations: the effect of short-term CPAP therapy and their association with the severity of obstructive sleep apnea. J Clin Sleep Med 2022; 18:361-371. [PMID: 34314347 PMCID: PMC8804991 DOI: 10.5664/jcsm.9564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES We determined the relationship of cardiovascular risk factors, cardiovascular diseases, nocturnal blood pressure (NBP), and NBP fluctuations (NBPFs) with the severity of obstructive sleep apnea (OSA). We also investigated the effect of short-term continuous positive airway pressure therapy on NBP parameters. METHODS This retrospective study included 548 patients from our cardiac clinic with suspected OSA. Patients underwent polysomnography and continuous NBP measurement using the pulse transit time. According to their apnea-hypopnea index (AHI), patients were subclassified as controls (AHI < 5 events/h), mild (AHI 5 to < 15 events/h), moderate (AHI 15 to < 30 events/h), and severe OSA (AHI ≥ 30 events/h); 294 patients received continuous positive airway pressure therapy. RESULTS Analysis of covariance showed that NBP and the frequency of NBPFs were the highest in severe followed by moderate and mild OSA (all P < .001). Multivariable regression analysis revealed a significant association of NBPFs with AHI, body mass index, systolic NBP, and lowest SpO2. The severity of OSA is also associated with the frequency of obesity, hypertension, diabetes mellitus, atrial fibrillation, heart failure (all P < .001), and coronary artery disease (P = .035). Short-term continuous positive airway pressure decreased the frequency of NBPFs in all OSA groups and the systolic NBP in severe and moderate but not in mild OSA. CONCLUSIONS The severity of OSA is associated with an increase in NBP and NBPFs. Continuous positive airway pressure reduces NBP parameters already after the first night. In addition to BP, the diagnosis and therapy of NBPFs should be considered in patients with OSA. CLINICAL TRIAL REGISTRATION Registry: German Clinical Trials Register; Name: Nocturnal blood pressure and nocturnal blood pressure fluctuations associated with the severity of obstructive sleep apnea; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024087; Identifier: DRKS00024087. CITATION Picard F, Panagiotidou P, Tammen A-B, et al. Nocturnal blood pressure and nocturnal blood pressure fluctuations: the effect of short-term CPAP therapy and their association with the severity of obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):361-371.
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Affiliation(s)
- Frauke Picard
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany,Address correspondence to: Dr. Frauke Picard, PhD, Augusta-Krankenhaus, Akademisches Lehrkrankenhaus der Universität Düsseldorf, Klinik für Kardiologie, Amalienstraße 9, 40472 Düsseldorf;
| | - Petroula Panagiotidou
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Anne-Beke Tammen
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Anamaria Wolf-Pütz
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Maximilian Steffen
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Hanno Julian Gerhardy
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | | | - Rolf Michael Klein
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany,Department of Cardiology, University Hospital Witten/Herdecke, Witten, Germany
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Peñacoba P, Llauger MA, Fortuna AM, Flor X, Sampol G, Pedro-Pijoan AM, Grau N, Santiveri C, Juvanteny J, Aoiz JI, Bayó J, Lloberes P, Mayos M. A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study. BMC Pulm Med 2022; 22:38. [PMID: 35033055 PMCID: PMC8761286 DOI: 10.1186/s12890-022-01827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting. Methods Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed. Results 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763–0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863–0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7–92.1) and specificity of 67.8% (95% CI 55.1–78.3). Conclusions The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979. Date of registration: October 30, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01827-0.
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Affiliation(s)
- Patricia Peñacoba
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Maria Antònia Llauger
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Equip d'Atenció Primària Encants, Centre d'Atenció Primària (CAP) Maragall, Institut Català de La Salut, Barcelona, Spain
| | - Ana María Fortuna
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Flor
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Chafarinas, Institut Català de La Salut, Barcelona, Spain
| | - Gabriel Sampol
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Núria Grau
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain.,Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain
| | - Carme Santiveri
- Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Juvanteny
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Trinitat Vella, Institut Català de La Salut, Barcelona, Spain
| | | | - Joan Bayó
- CAP El Clot, Institut Català de La Salut, Barcelona, Spain
| | - Patricia Lloberes
- Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
| | - Mercè Mayos
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
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11
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The Future of Sleep Medicine: A Patient-Centered Model of Care. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Peñacoba Toribio P, Fortuna Gutiérrez AM, Mayos Pérez M. Manejo de la apnea obstructiva del sueño en atención primaria en relación con el nuevo documento de consenso internacional. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497177 PMCID: PMC10369519 DOI: 10.1016/j.opresp.2021.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Antonio Madrid J, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncoso Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. [Translated article] International consensus document on obstructive sleep apnea. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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14
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Corrigan J, Tsai WH, Ip-Buting A, Ng C, Ogah I, Peller P, Sharpe H, Laratta C, Pendharkar SR. Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study. J Clin Sleep Med 2021; 18:1013-1020. [PMID: 34823649 DOI: 10.5664/jcsm.9776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether adherence to continuous positive airway pressure (CPAP) in adults with uncomplicated OSA differs by rural versus urban residential address. METHODS In this prospective cohort study, we recruited adults who initiated CPAP for uncomplicated OSA that was diagnosed by a physician using sleep specialist-interpreted diagnostic testing. Participants were classified as urban (community size > 100,000) or rural by translating residential postal code into geographic census area. The primary outcome was mean daily hours of CPAP use compared between rural and urban patients. Secondary outcomes included: the proportion of patients who were adherent to CPAP; change in Epworth Sleepiness Scale (ESS) score; change in EuroQOL-5D score; and Visit-Specific Satisfaction Instrument score. All outcomes were measured three months after CPAP initiation. RESULTS We enrolled 242 patients (100 rural) with mean (SD) age 51 (13) years and respiratory event index 24 (18) events/hour. Mean (95% CI) CPAP use was 3.19 (2.8,3.58) hours/night and 35% were CPAP-adherent, with no difference between urban and rural patients. Among the 65% of patients who were using CPAP at three months, mean CPAP use was 4.89 (4.51,5.28) hours/night and was not different between rural and urban patients. Improvement in ESS and patient satisfaction were similar between groups, but EuroQOL-5D score improved to a greater extent in rural patients. Urban or rural residence was not associated with CPAP adherence in multivariable regression analysis. CONCLUSIONS Rural versus urban residence was not associated with differences in CPAP adherence when guided by specialist-interpreted diagnostic sleep testing.
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Affiliation(s)
- Jennifer Corrigan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Willis H Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ada Ip-Buting
- Ward of the 21st Century Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Imhokhai Ogah
- Department of Medicine, Queen's University, Kingston, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Canada
| | - Heather Sharpe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Cheryl Laratta
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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15
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Grivell N, Haycock J, Redman A, Vakulin A, Zwar N, Stocks N, Frank O, Reed R, Chai-Coetzer CL, Grunstein RR, McEvoy RD, Hoon E. Assessment, referral and management of obstructive sleep apnea by Australian general practitioners: a qualitative analysis. BMC Health Serv Res 2021; 21:1248. [PMID: 34794444 PMCID: PMC8601775 DOI: 10.1186/s12913-021-07274-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background The high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery. However, little is known about the current involvement, experiences and attitudes of Australian general practitioners towards OSA. The purpose of this study was to provide an in-depth analysis of Australian general practitioners’ experiences and opinions regarding their care of patients with OSA to inform the design and implementation of new general practice models of care. Methods Purposive sampling was used to recruit participants with maximum variation in age, experience and location. Semi-structured interviews were conducted and were analysed using Thematic Analysis. Results Three major themes were identified: (1) General practitioners are important in recognising symptoms of OSA and facilitating a diagnosis by others; (2) Inequities in access to the assessment and management of OSA; and (3) General practitioners currently have a limited role in the management of OSA. Conclusions When consulting with patients with symptoms of OSA, general practitioners see their primary responsibility as providing a referral for diagnosis by others. General practitioners working with patients in areas of greater need, such as rural/remote areas and those of socio-economic disadvantage, demonstrated interest in being more involved in OSA management. Inequities in access to assessment and management are potential drivers for change in future models of care for OSA in general practice.
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Affiliation(s)
- Nicole Grivell
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia. .,FHMRI Sleep/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Box 6, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA, Australia.
| | - Jenny Haycock
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,FHMRI Sleep/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Box 6, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA, Australia
| | - Anne Redman
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,Sax Institute, Glebe, NSW, Australia
| | - Andrew Vakulin
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,FHMRI Sleep/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Box 6, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA, Australia
| | - Nicholas Zwar
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,Faculty of Health Sciences & Medicine, Bond University, Robina, QLD, Australia
| | - Nigel Stocks
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
| | - Oliver Frank
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
| | - Richard Reed
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,Discipline of General Practice, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ching Li Chai-Coetzer
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,FHMRI Sleep/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Box 6, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA, Australia.,Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Ronald R Grunstein
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.,Woolcock Institute of Medical Research, Glebe, NSW, Australia.,Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia
| | - R Doug McEvoy
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,FHMRI Sleep/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Box 6, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA, Australia
| | - Elizabeth Hoon
- National Centre for Sleep Health Services Research, Bedford Park, SA, Australia.,Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
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16
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Primary vs. Specialist Care for Obstructive Sleep Apnea: A Systematic Review and Individual Participant Data Level Meta-Analysis. Ann Am Thorac Soc 2021; 19:668-677. [PMID: 34524936 DOI: 10.1513/annalsats.202105-590oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Primary care clinicians may be well placed to play a greater role in obstructive sleep apnea management. OBJECTIVES To evaluate the outcomes and cost-effectiveness of sleep apnea management in primary versus specialist care, using an individual-participant data meta-analysis to determine whether age, gender, severity of OSA and daytime sleepiness impacted outcomes. METHODS Data sources were CINAHL, CENTRAL, MEDLINE Ovid SP, Scopus, ProQuest, US NIH Ongoing Trials Register, ISRCTN registry [inception until 09-25-2019]. Hand-searching was undertaken. Two authors independently assessed articles and included trials that randomized adults with a suspected diagnosis of sleep apnea to primary versus specialist management within the same study and reported daytime sleepiness using the Epworth Sleepiness Scale (range 0-24; >10 indicates pathological sleepiness; minimum clinically important difference two units) at baseline and follow-up. RESULTS The primary analysis combined data from 970 (100%) participants (four trials). Risk of bias was assessed (Cochrane Tool). One-stage intention-to-treat analysis showed a slightly smaller decrease in daytime sleepiness (0.8; 0.2 to 1.4), but greater reduction in diastolic blood pressure in primary care (-1.9; -3.2 to -0.6 mmHg), with similar findings in the per protocol analysis. Primary care-based within-trial healthcare system costs per participant were lower (-$448.51 USD), and quality-adjusted life years and daytime sleepiness improvements were less expensive. Similar primary outcome results were obtained for sub-groups in both management settings. CONCLUSIONS Similar outcomes in primary care at a lower cost provide strong support for implementation of primary care-based management of sleep apnea. Registration: PROSPERO (CRD42020154688).
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17
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Chai-Coetzer CL, Eastwood PR. Diagnosing OSA in primary care: The utility of clinical judgement, screening questionnaires and portable monitoring. Respirology 2021; 26:908-909. [PMID: 34427021 DOI: 10.1111/resp.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ching Li Chai-Coetzer
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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18
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Chapman JL, Hoyos CM, Killick R, Sutherland K, Cistulli PA, Zwar N, Yee BJ, Marks G, Grunstein RR, Wong KKH. Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care. Respirology 2021; 26:989-996. [PMID: 34342088 DOI: 10.1111/resp.14122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/08/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Use of in-laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care. METHODS Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single-channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in-laboratory PSG was the reference test, with OSA defined as apnoea-hypopnoea index (AHI) ≥10 events/h. RESULTS In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53-0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients. CONCLUSION Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes.
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Affiliation(s)
- Julia L Chapman
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,School of Psychology and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,School of Psychology and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Roo Killick
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Kate Sutherland
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Nick Zwar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Brendon J Yee
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Guy Marks
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Charles Perkins Centre-Royal Prince Alfred Clinic, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Keith K H Wong
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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19
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Pendharkar SR, Blades K, Kelly JE, Tsai WH, Lien DC, Clement F, Woiceshyn J, McBrien KA. Perspectives on primary care management of obstructive sleep apnea: a qualitative study of patients and health care providers. J Clin Sleep Med 2021; 17:89-98. [PMID: 32975193 DOI: 10.5664/jcsm.8814] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Difficulties in providing timely access to care have prompted interest in primary care delivery models for obstructive sleep apnea (OSA). Sustainable implementation of such models requires codesign with input from key stakeholders. The purpose of this study was to identify patient and provider perspectives on barriers and facilitators to optimal, patient-centered management of OSA in a primary care setting. METHODS This study was conducted in Alberta, Canada. Data from key stakeholders were collected through an online survey of primary care providers (n = 119), focus groups and interviews with patients living with OSA (n = 28), and workshops with primary care and sleep providers (n = 36). Quantitative survey data were reported using descriptive statistics, and qualitative data were analyzed using an inductive thematic approach. RESULTS Several barriers were identified, including poor specialist access, variable primary care providers knowledge of OSA, and lack of clarity about provider roles for OSA management. Barriers contributed to patients being poorly informed about OSA, leading them to separate OSA from their overall health and eroding trust in the system. Suggestions for improvement included integration of care providers in a comprehensive model of care, facilitated by improved system navigation and more effective use of technology. Themes were consistent across data collection methods and between stakeholder groups. CONCLUSIONS Although primary care delivery models may improve access to OSA management, stakeholders identified important challenges in the current system. Innovative models of care, developed with input from patients and providers, may mitigate barriers and support optimal primary care management of OSA.
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Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Blades
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenny E Kelly
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dale C Lien
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jaana Woiceshyn
- Haskayne School of Business, University of Calgary, Calgary, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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20
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Peñacoba P, Llauger MA, Fortuna AM, Flor X, Sampol G, Pedro Pijoan AM, Grau N, Santiveri C, Juvanteny J, Aoiz JI, Bayó J, Lloberes P, Mayos M. Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain. J Clin Sleep Med 2021; 16:1579-1589. [PMID: 32279702 DOI: 10.5664/jcsm.8492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.
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Affiliation(s)
- Patricia Peñacoba
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Antònia Llauger
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Equip d'Atenció Primària Encants, Centre d'Atenció Primària (CAP) Maragall, Institut Català de la Salut, Barcelona, Spain
| | - Ana M Fortuna
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Flor
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Chafarinas, Institut Català de la Salut, Barcelona, Spain
| | - Gabriel Sampol
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Núria Grau
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain
| | - Carme Santiveri
- Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Juvanteny
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Trinitat Vella, Institut Català de la Salut, Barcelona, Spain
| | | | - Joan Bayó
- CAP El Clot, Institut Català de la Salut, Barcelona, Spain
| | - Patricia Lloberes
- Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
| | - Mercè Mayos
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
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21
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King S, Damarell R, Schuwirth L, Vakulin A, Chai-Coetzer CL, McEvoy RD. Knowledge to action: a scoping review of approaches to educate primary care providers in the identification and management of routine sleep disorders. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2021; 17:2307-2324. [PMID: 33983109 DOI: 10.5664/jcsm.9374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The referral burden on healthcare systems for routine sleep disorders could be alleviated by educating primary care providers (PCPs) to diagnose and manage patients with sleep health issues. This requires effective professional education strategies and resources. This scoping review examined the literature on existing approaches to educate PCPs in sleep health management. METHODS A comprehensive literature search was conducted across eight databases to identify citations describing the education of PCPs in diagnosing and managing sleep disorders, specifically insomnia and sleep apnea. A conceptual framework, developed from the knowledge-to-action cycle, was used to analyze citations from a knowledge translation perspective. RESULTS Searches identified 616 unique citations and after selection criteria were applied, 22 reports were included. Reports spanning 38 years were analyzed using components of the knowledge-to-action cycle to understand how educational interventions were designed, developed, implemented, and evaluated. Interventions involved didactic (32%), active (18%) and blended (41%) approaches, using face-to-face (27%), technology-mediated (45%) and multimodal (5%) delivery. Educational effectiveness was assessed in 73% of reports, most commonly using a pre/post questionnaire (41%). CONCLUSIONS While this scoping review has utility in describing existing educational interventions to upskill PCPs to diagnose and manage sleep disorders, the findings suggest that interventions are often developed without explicitly considering the evidence of best educational practice. Future interventional designs may achieve greater sustained effectiveness by considering characteristics of the target audience, the pedagogical approaches best suited to its needs, and any environmental drivers and barriers that might impede the translation of evidence into practice.
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Affiliation(s)
- Svetlana King
- Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University
| | - Raechel Damarell
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lambert Schuwirth
- Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute Sleep Health / Adelaide Institute of Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence
| | - Ching Li Chai-Coetzer
- Flinders Health and Medical Research Institute Sleep Health / Adelaide Institute of Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence
| | - R Doug McEvoy
- Flinders Health and Medical Research Institute Sleep Health / Adelaide Institute of Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence
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22
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Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Madrid JA, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncos Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. International Consensus Document on Obstructive Sleep Apnea. Arch Bronconeumol 2021; 58:52-68. [PMID: 33875282 DOI: 10.1016/j.arbres.2021.03.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).
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Affiliation(s)
- Olga Mediano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Nicolás González Mangado
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | - Josep M Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar de Patología del Sueño y VNID, Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M Luz Alonso-Álvarez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Dr. J. Terán Santos, Departamento de Neumología, Hospital Universitario de Burgos, Burgos, España
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Alberto Alonso-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Baleares, España
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova y Santa Maria, Lleida, España
| | - Eduardo Borsini
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño y Ventilación, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Candelaria Caballero-Eraso
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Departamento de Neumología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Felix de Carlos Villafranca
- Servicio de Estomatología, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Asturias, España
| | - Carmen Carmona-Bernal
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Jose Luis Carrillo Alduenda
- Unidad de Medicina del Sueño, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, México
| | - Eusebi Chiner
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, España
| | - José Aurelio Cordero Guevara
- Grupo de Investigación en Epidemiología y Salud Pública, Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Luis de Manuel
- Corte del Ilustre Colegio de Abogados de Madrid, Madrid, España
| | - Joaquín Durán-Cantolla
- Servicio de Investigación, Instituto de Investigación, OSI Araba, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, España
| | - Ramón Farré
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Carlos Franceschini
- Unidad de Sueño y Ventilación Mecánica, Hospital Cosme Argerich, Buenos Aires, Argentina
| | - Carles Gaig
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Pedro Garcia Ramos
- Centro de Salud Don Benito Oeste, Servicio Extremeño de Salud, Don Benito, Badajoz, España
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Onintza Garmendia
- Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Barcelona, España
| | - Teresa Gómez García
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | - Silvia González Pondal
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | | | - Albert Lecube
- Grupo de investigación en Obesidad, Diabetes y Metabolismo (ODIM), Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - Juan Antonio Madrid
- Laboratorio de Cronobiología, Universidad de Murcia, IMIB-Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, España
| | - Lourdes Maniegas Lozano
- Fundación Jiménez Díaz, Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | | | - Juan Fernando Masa
- Hospital San Pedro de Alcántara, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), San Pedro de Alcántara, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - María José Masdeu Margalef
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercè Mayos Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Carmen Monasterio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Nieves Navarro Soriano
- Unidad de Sueño, Servicio de Neumología, Hospital Clínico Universitario, Valencia, España
| | - Erika Olea de la Fuente
- Servicio de Anestesiología y Reanimación, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España; Hospital Universitario La Zarzuela, Madrid, España
| | - Francisco Javier Puertas Cuesta
- Unidad de Sueño, Servicio de Neurofisiología, Hospital Universitario de La Ribera, Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Alzira, Valencia, España
| | - Claudio Rabec
- Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, Francia
| | - Pilar Resano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - Alejandra Roncero
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital San Pedro, Logroño, La Rioja, España
| | - Concepción Ruiz
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Neus Salord
- Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Adriana Saltijeral
- Servicio de Cardiología, Hospital Universitario del Tajo, Universidad Alfonso X El Sabio, Aranjuez, Madrid, España
| | - Gabriel Sampol Rubio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - M Ángeles Sánchez Quiroga
- Hospital Virgen del Puerto, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Plasencia, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Óscar Sans Capdevila
- Unidad del Sueño, Servicio de Neurología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - Carlos Teixeira
- European Society of Sleep Technologists (EEST), Porto, Portugal
| | - Francisco Tinahones Madueño
- Sociedad Española para el Estudio de la Obesidad (SEEDO), Madrid, España; Servicio de Endocrinología, Hospital Virgen de la Victoria, (IBIMA), Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - Sônia Maria Togeiro
- Disciplina de Pneumologia, Departamento de Medicina; Disciplina de Medicina y Biologia del Sueño - Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brasil
| | | | | | - Joao Winck
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Álava, España
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Chai-Coetzer CL, Redman S, McEvoy RD. Can primary care providers manage obstructive sleep apnea? J Clin Sleep Med 2021; 17:1-2. [PMID: 33164743 DOI: 10.5664/jcsm.8990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia.,Respiratory and Sleep Service, South Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Sally Redman
- Sax Institute, Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
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Billings ME, Pendharkar SR. Alternative Care Pathways for Obstructive Sleep Apnea and the Impact on Positive Airway Pressure Adherence: Unraveling the Puzzle of Adherence. Sleep Med Clin 2020; 16:61-74. [PMID: 33485532 DOI: 10.1016/j.jsmc.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The high burden of obstructive sleep apnea (OSA), combined with inadequate supply of sleep specialists and constraints on polysomnography resources, has prompted interest in alternative models of care to improve access and treatment effectiveness. In appropriately selected patients, ambulatory clinical pathways and use of nonphysicians or primary care providers to manage OSA can improve timely access and costs without compromising adherence or other clinical outcomes. Although initial studies show promising results, there are several potential barriers that must be considered before broad implementation, and further implementation research and economic evaluation studies are required.
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Affiliation(s)
- Martha E Billings
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, UW Medicine Sleep Center at Harborview Medical Center, Box 359803, 325 Ninth Avenue, Seattle, WA 98104, USA.
| | - Sachin R Pendharkar
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, Room 3E23, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada
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Tserenpil G, Gebre M, Zergham AS, Sekhon AK, Malik BH. Managements for Obstructive Sleep Apnea in Adults: Review. Cureus 2020; 12:e9905. [PMID: 32968568 PMCID: PMC7505527 DOI: 10.7759/cureus.9905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/20/2020] [Indexed: 11/11/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent obstruction of the pharyngeal airway during sleep, with resultant hypoxia and sleep fragmentation. It is more common in middle-aged obese men and prevalence is higher in most obese people. However, prevalence is high in African-Americans. OSA is associated with major comorbidities including excessive daytime sleepiness and increased risk of cardiovascular diseases. First and foremost, OSA management starts from educating patients about short-term consequences like motor vehicle accidents, behavioral modifications, long term consequences like cardiopulmonary disease, and resistant high blood pressure. Various types of management options are available for OSA such as weight loss, CPAP, oral appliances, and surgery. The review aims to explain the pathophysiology and cause of the obstruction of the airway in order to choose proper management carefully to decrease the symptoms and cure the disease.
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Affiliation(s)
- Gantuya Tserenpil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Meklit Gebre
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Azka Shahid Zergham
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amanpreet Kaur Sekhon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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González Mangado N, Egea-Santaolalla CJ, Chiner Vives E, Mediano O. Apnea obstructiva del sueño. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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27
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Pépin JL, Letesson C, Le-Dong NN, Dedave A, Denison S, Cuthbert V, Martinot JB, Gozal D. Assessment of Mandibular Movement Monitoring With Machine Learning Analysis for the Diagnosis of Obstructive Sleep Apnea. JAMA Netw Open 2020; 3:e1919657. [PMID: 31968116 PMCID: PMC6991283 DOI: 10.1001/jamanetworkopen.2019.19657] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Given the high prevalence of obstructive sleep apnea (OSA), there is a need for simpler and automated diagnostic approaches. OBJECTIVE To evaluate whether mandibular movement (MM) monitoring during sleep coupled with an automated analysis by machine learning is appropriate for OSA diagnosis. DESIGN, SETTING, AND PARTICIPANTS Diagnostic study of adults undergoing overnight in-laboratory polysomnography (PSG) as the reference method compared with simultaneous MM monitoring at a sleep clinic in an academic institution (Sleep Laboratory, Centre Hospitalier Universitaire Université Catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium). Patients with suspected OSA were enrolled from July 5, 2017, to October 31, 2018. MAIN OUTCOMES AND MEASURES Obstructive sleep apnea diagnosis required either evoking signs or symptoms or related medical or psychiatric comorbidities coupled with a PSG-derived respiratory disturbance index (PSG-RDI) of at least 5 events/h. A PSG-RDI of at least 15 events/h satisfied the diagnosis criteria even in the absence of associated symptoms or comorbidities. Patients who did not meet these criteria were classified as not having OSA. Agreement analysis and diagnostic performance were assessed by Bland-Altman plot comparing PSG-RDI and the Sunrise system RDI (Sr-RDI) with diagnosis threshold optimization via receiver operating characteristic curves, allowing for evaluation of the device sensitivity and specificity in detecting OSA at 5 events/h and 15 events/h. RESULTS Among 376 consecutive adults with suspected OSA, the mean (SD) age was 49.7 (13.2) years, the mean (SD) body mass index was 31.0 (7.1), and 207 (55.1%) were men. Reliable agreement was found between PSG-RDI and Sr-RDI in patients without OSA (n = 46; mean difference, 1.31; 95% CI, -1.05 to 3.66 events/h) and in patients with OSA with a PSG-RDI of at least 5 events/h with symptoms (n = 107; mean difference, -0.69; 95% CI, -3.77 to 2.38 events/h). An Sr-RDI underestimation of -11.74 (95% CI, -20.83 to -2.67) events/h in patients with OSA with a PSG-RDI of at least 15 events/h was detected and corrected by optimization of the Sunrise system diagnostic threshold. The Sr-RDI showed diagnostic capability, with areas under the receiver operating characteristic curve of 0.95 (95% CI, 0.92-0.96) and 0.93 (95% CI, 0.90-0.93) for corresponding PSG-RDIs of 5 events/h and 15 events/h, respectively. At the 2 optimal cutoffs of 7.63 events/h and 12.65 events/h, Sr-RDI had accuracy of 0.92 (95% CI, 0.90-0.94) and 0.88 (95% CI, 0.86-0.90) as well as posttest probabilities of 0.99 (95% CI, 0.99-0.99) and 0.89 (95% CI, 0.88-0.91) at PSG-RDIs of at least 5 events/h and at least 15 events/h, respectively, corresponding to positive likelihood ratios of 14.86 (95% CI, 9.86-30.12) and 5.63 (95% CI, 4.92-7.27), respectively. CONCLUSIONS AND RELEVANCE Automatic analysis of MM patterns provided reliable performance in RDI calculation. The use of this index in OSA diagnosis appears to be promising.
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Affiliation(s)
- Jean-Louis Pépin
- Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes (CHUGA), Université Grenoble Alpes, Institut National de la Santé et de la Recherche Medicale, Grenoble, France
| | | | | | | | | | - Valérie Cuthbert
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Jean-Benoît Martinot
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
- Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia
- Child Health Research Institute, University of Missouri, Columbia
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Mediano O, Cano-Pumarega I, Sánchez-de-la-Torre M, Alonso-Álvarez ML, Troncoso MF, García-Río F, Egea C, Durán-Cantolla J, Terán-Santos J, Barbé F, Fernando Masa J, Montserrat JM. Upcoming Scenarios for the Comprehensive Management of Obstructive Sleep Apnea: An Overview of the Spanish Sleep Network. Arch Bronconeumol 2020; 56:35-41. [DOI: 10.1016/j.arbres.2019.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
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A Randomized Controlled Trial of an Alternative Care Provider Clinic for Severe Sleep-disordered Breathing. Ann Am Thorac Soc 2019; 16:1558-1566. [DOI: 10.1513/annalsats.201901-087oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Coordinated program between primary care and sleep unit for the management of obstructive sleep apnea. NPJ Prim Care Respir Med 2019; 29:39. [PMID: 31704942 PMCID: PMC6841945 DOI: 10.1038/s41533-019-0151-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023] Open
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.
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Donovan LM, Shah A, Chai-Coetzer CL, Barbé F, Ayas NT, Kapur VK. Redesigning Care for OSA. Chest 2019; 157:966-976. [PMID: 31639334 DOI: 10.1016/j.chest.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Constrained by a limited supply of specialized personnel, health systems face a challenge in caring for the large number of patients with OSA. The complexity of this challenge is heightened by the varied clinical presentations of OSA and the diversity of treatment approaches. Innovations such as simplified home-based care models and the incorporation of nonspecialist providers have shown promise in the management of uncomplicated patients, producing comparable outcomes to the resource-intensive traditional approach. However, it is unclear if these innovations can meet the needs of all patients with OSA, including those with mild disease, atypical presentations, and certain comorbid medical and mental health conditions. This review discusses the diversity of needs in OSA care, the evidence base behind recent care innovations, and the potential limitations of each innovation in meeting the diversity of care needs. We propose how these innovations can fit within the stepped care and hub and spoke models in a way that addresses the full spectrum of OSA, and we discuss future research directions to assess the deployment of these innovations.
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Affiliation(s)
- Lucas M Donovan
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA; University of Washington School of Medicine, Seattle, WA
| | - Aditi Shah
- Leon Judah Blackmore Sleep Disorders Program, University of British Columbia, Vancouver, BC, Canada
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Ferran Barbé
- Institut de Recerca Biomèdica of Lleida and CIBERES, Lleida, Catalonia, Spain
| | - Najib T Ayas
- Leon Judah Blackmore Sleep Disorders Program, University of British Columbia, Vancouver, BC, Canada
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Suarez-Giron M, Bonsignore MR, Montserrat JM. New organisation for follow-up and assessment of treatment efficacy in sleep apnoea. Eur Respir Rev 2019; 28:28/153/190059. [PMID: 31511256 PMCID: PMC9488453 DOI: 10.1183/16000617.0059-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared with the growing needs for OSA diagnosis and management, and alternative strategies need to be developed to optimise the OSA clinical pathway. In this review, we propose a management strategy for OSA, and in general for sleep-disordered breathing, to be implemented from diagnosis to follow-up. For this purpose, the best current options seem to be: 1) networking at different levels of care, from primary physicians to specialised sleep laboratories; and 2) use of telemedicine. Telemedicine can contribute to the improved cost-effectiveness of OSA management during both the diagnostic and therapeutic phases. However, although the technology is already in place and different commercial platforms are in use, it is still unclear how to use telemedicine effectively in the sleep field. Application of telemedicine for titration of positive airway pressure treatment, follow-up to improve compliance to treatment through early identification and solution of problems, and teleconsultation all appear to be promising areas for improved OSA management. Telemedicine could improve the management of sleep apnoea and other breathing disorders during sleep.http://bit.ly/2XPoPW1
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