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Primary care physicians, sleep specialists equally manage OSA
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Care provided by a sleep specialist or non-sleep specialist, such as a primary care physician, resulted in similar outcomes in patients with suspected or diagnosed obstructive sleep apnea, according to research published in Annals of Internal Medicine.
“Obstructive sleep apnea (OSA) is common, can negatively affect quality of life and work productivity, and current diagnostic and treatment approaches are burdensome and costly,” Timothy J. Wilt, MD, MPH, senior author from Minneapolis VA Health Care System Evidence-based Synthesis Program and the University of Minnesota School of Medicine, told Healio Internal Medicine.
“Newer treatment models have been proposed that could improve health care access and reduce costs while maintaining care quality by expanding options beyond sleep specialists to include providers not specifically trained as sleep specialists, such as nurses or primary care physicians,” he added.
Wilt and colleagues performed a systematic review of 12 randomized trials and observational studies to investigate whether case-finding accuracy, harms and effectiveness of care among patients with known or suspected OSA differed between sleep specialists and non-sleep specialists.
The researchers evaluated the studies for patient-centered outcomes, such as mortality, access to care, quality of life, patient satisfaction, adherence, symptom scores and adverse events. They also evaluated other outcomes, such as resource use, costs, time to initiation of treatment and case finding.
Low-strength evidence from four observational studies (n = 580; mean age 52 years; 77% male) revealed that appropriate diagnostic testing and classification of OSA severity was similar between sleep specialists and non-sleep specialists. Additionally, low-strength evidence from five randomized trials and three observational studies (n = 1,515; mean age, 52 years; 68% male) showed that quality of life, adherence and symptom scores did not differ among patients cared for by sleep specialists compared with non-sleep specialists.
There was insufficient evidence to compare access to care and adverse events.
The researchers noted limitations, including that many non-sleep specialists involved in the study were extensively trained or had experience in sleep medicine.
“Our report helps clinicians and health care systems determine the role of different health care provider types in identifying and treating patients with suspected OSA,” Wilt said. “Next steps include additional studies to determine if this approach improves access to care and patient satisfaction while reducing costs and whether findings from research settings apply to generalized clinical care situations and providers with different levels of experience and training.” “Until then, health care systems and clinicians can implement our findings by targeting OSA assessment and treatment to individuals most likely to benefit (ie, individuals with unexplained daytime sleepiness) and potentially expanding use of well-trained non-sleep specialist providers especially where sleep specialists are in limited supply and demand for OSA diagnosis and care is high,” he said. – by Alaina Tedesco
Disclosure: The authors report no relevant financial disclosures.