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OSA treatment centres

Location for OSA treatment does not impact outcomes

Adelaide Institute for Sleep Health (Ashford Hospital)
Lower costs reported at primary care centres

Treatment for moderate-to-severe obstructive sleep apnoea at a primary care centre is not clinically inferior to treatment at a specialist sleep centre, according to a study from the Adelaide Institute for Sleep Health, South Australia. The study, which compared the outcomes from patients who were treated at primary care or specialist centre, also reported that costs were lower for the patient group treated at primary centres.

"One-third of primary care patients report symptoms suggestive of obstructive sleep apnoea,” the study authors write. “With appropriate training and simplified management tools, primary care physicians and practice nurses might be ideally positioned to take on a greater role in diagnosis and management."

The research, which was published in JAMA, reported that there were significant improvements in Epworth Sleepiness Scale (ESS) scores from baseline to six months in both groups. The mean ESS for the entire study population was 12.6; scores in the primary care group improved from 12.8 at baseline to 7.0 at six months (adjusted mean difference of 5); and in the specialist group from a baseline mean of 12.5 to 7.0 at six months (an adjusted mean difference of 5.4). After controlling for baseline ESS score and region, the adjusted difference in the mean change in the ESS score was -0.13.

This randomised, controlled, non-inferiority study included 155 patients with obstructive sleep apnoea, between September 2008 and June 2010. Both interventions included continuous positive airway pressure, mandibular (lower jaw) advancement splints or conservative measures only.

Seventeen patients withdrew from the study in the primary care group vs six patients in the specialist group. There were no differences in secondary outcome measures between groups with adherence to continuous positive airway pressure the same in both groups at six months.

An analysis of within-trial sleep-related diagnostic and treatment costs revealed that primary care management of obstructive sleep apnoea was approximately 40% less expensive than specialist care. The equivalent total average costs per patient were estimated at US$1,819 in the primary care group and US$3,068 in the specialist group. Sleep study costs, sleep physician consultations, and travel costs appeared to be the main contributors to the increased within-trial costs in the specialist group.

”Among patients with obstructive sleep apnoea, treatment under a primary care model compared with a specialist model did not result in worse sleepiness scores, suggesting that the two treatment modes may be comparable,” the authors conclude. “With appropriate funding models to support an ambulatory strategy, primary care management of obstructive sleep apnoea has the potential to improve patient access to sleep services. This would be particularly beneficial for rural and remote regions, as well as developing nations, where access to specialist services can be limited.”

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