SAN FRANCISCO – Outpatient sleep apnea management by primary care physicians and nurses works as well as management by specialists in a sleep center and is less expensive, Australian researchers reported at the International Conference of the American Thoracic Society.
The team randomized 155 patients with symptomatic, moderate to severe obstructive sleep apnea (OSA) – all with baseline Epworth Sleepiness Scale (ESS) scores of at least 8 – to either standard management by sleep specialists with sleep-lab testing or outpatient management by their primary care doctor and a community-based nurse. Primary care management often involved home-based, autotitrating CPAP (continuous positive airway pressure), but providers in both arms were free to prescribe whatever treatment they thought best.
Obstructive sleep apnea had first been diagnosed by the primary care doctors using screening and ESS questionnaires, plus home oximetry testing with the ApneaLink device, manufactured by ResMed. They and the nurses had six hours of OSA training before the trial, plus training about common sleep disorders and their differential diagnoses. Nurses had an additional week of training at a sleep center.
After 6 months, patients managed by the primary care group had a mean ESS improvement of 4.9 points and a mean Functional Outcomes of Sleep Questionnaire (FOSQ) improvement of 2.3 points. The mean ESS improvement in the specialist group was 5.1, and the mean FOSQ improvement was 2.7. The differences were not statistically significant.
CPAP machines were being used a mean of 4.8 hours per day at 6 months in the primary care group and a mean of 5.4 hours per day in the specialist group. Again, the difference was not significant.
Outpatient OSA management saved more than $2,000 (AUS) per patient, as well.
"Our results show that using a simplified, ambulatory approach for the treatment of OSA in primary care is not clinically inferior to management of these patients in a specialist sleep center," said lead investigator Dr. Ching Li Chai-Coetzer of the Adelaide Institute for Sleep Health at the Repatriation General Hospital in Adelaide, Australia.
"We think in rural, remote areas and in the developing world, as obesity emerges and sleep apnea becomes more of a clinical issue, the traditional models of care are not going to be available to all patients. We think these results may have some important implications in these areas," said Dr. Nicholas Antic, also an investigator from the Adelaide Institute for Sleep Health.
Dr. Chai-Coetzer and Dr. Antic said they had no relevant financial conflicts. The equipment used in the study was donated by ResMed, Philips Respironics, and SomnoMed.