Primary care and specialists have comparable outcomes in treating Sleep Apnea

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1. Both primary care and specialist centers reported improvement in ESS (Epworth Sleepiness Scale) Scores without clinically significant differences .

2. There were no differences in secondary outcomes between patients treated at primary care or specialist centers either.

Published today in JAMA, the present study investigated whether there is a difference in outcomes for patients with OSA being treated by primary care physicians or specialist sleep center physicians. While significant improvements in daytime sleepiness were observed in both primary care and specialist groups, primary care was not inferior to specialist groups. This concurs with previous studies which found no outcome differences between ambulatory, portable CPAP treatment vs. laboratory-based treatment. Although the study is well designed, it could have expand its applicability by including more females (>75% male in both groups) and diversifying treatment beyond CPAP (e.g. lifestyle changes, mandibular advancement splints), in addition to addressing strategies to maintain and continue the education of primary care physicians on OSA management beyond the duration of the study. Nonetheless, the findings are important, especially since successful OSA management in primary care settings may improve rural patient access and decrease overall costs. Further cost-effectiveness analyses and randomized controlled trials will confirm those conclusions.

Click to read the study in JAMA
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1. Both primary care and specialist centers reported improvement in ESS (Epworth Sleepiness Scale) Scores without clinically significant differences .

2. There were no differences in secondary outcomes between patients treated at primary care or specialist centers either.

This [randomized, controlled, noninferiority] study: This study aimed to compare ESS score (Epworth Sleepiness Scale) and secondary outcomes (Functional Outcomes of
Sleep Questionnaire (FOSQ), CPAP adherence) at 6 months follow-up for a total of 155 patients between the age of 25 to 70 diagnosed with moderate to severe OSA in 4 locations in South Australia. They were randomized to ambulatory, primary care management or specialist sleep centers. The adjusted mean difference between baseline and 6 month ESS scores were 5.8 (95% CI, 4.4-7.2; P.001) and 5.4 (95% CI, 4.2-6.6; P.001) in the primary care and specialist groups, respectively. The adjusted difference in the mean change in the ESS score was -0.14 greater than the prespecified noninferiority margin of -2.0. There were no differences in mean FOSQ scores between the 2 groups. Total average within trial costs were greater in the specialist group compared to the primary group.

Further reading:

1. The Occurrence of Sleep-disordered Breathing Among Middle-Aged Adults

2. Portable Monitoring and Autotitration versus Polysomnography for the Diagnosis and Treatment of Sleep Apnea

In sum: Published today in JAMA, the present study investigated whether there is a difference in outcomes for patients with OSA being treated by primary care physicians or specialist sleep center physicians. While significant improvements in daytime sleepiness were observed in both primary care and specialist groups, primary care was not inferior to specialist groups. This concurs with previous studies which found no outcome differences between ambulatory, portable CPAP treatment vs. laboratory-based treatment. Although the study is well designed, it could have expand its applicability by including more females (>75% male in both groups) and diversifying treatment beyond CPAP (e.g. lifestyle changes, mandibular advancement splints), in addition to addressing strategies to maintain and continue the education of primary care physicians on OSA management beyond the duration of the study. Nonetheless, the findings are important, especially since successful OSA management in primary care settings may improve rural patient access and decrease overall costs. Further cost-effectiveness analyses and randomized controlled trials will confirm those conclusions.

Click to read the study in JAMA

By Elizabeth Park and Rif Rahman

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