Outcomes for sleep apnea appear comparable in primary and specialty care
Patients with sleep apnea had comparable outcomes after treatment in primary and specialty care, indicating that primary care physicians may be able to effectively treat the condition, a new study reports.
Patients with sleep apnea had comparable outcomes after treatment in primary and specialty care, indicating that primary care physicians may be able to effectively treat the condition, a new study reports.
Researchers in Australia performed a randomized, controlled, noninferiority study to compare the clinical efficacy of diagnosing and caring for sleep apnea using a simplified model in primary care and in specialist sleep centers. The study's primary outcome was change in Epworth Sleepiness Scale (ESS) score over six months; the scale ranges from a score of 0, or no daytime sleepiness, to 24, or high daytime sleepiness.
The study also examined disease-specific and general quality-of-life measures, symptoms of obstructive sleep apnea, adherence to continuous positive airway pressure, patient satisfaction and health care costs. Results appeared in the March 13 Journal of the American Medical Association.
Between September 2008 and June 2010, patients were assigned to treatment at primary care practices (n=81) or at a sleep medicine center at a university hospital (n=74). Most of the patients (81.3%) were men, with a mean age of 57.2 years in the primary care group and 54.5 years in the specialty care group. Mean body mass index was 33.1 kg/m2 in the primary care group and 33.7 kg/m2 in the specialty care group; patients with a body mass index higher than 50 kg/m2 were excluded. The treatment plans at both types of locations included positive airway pressure, mandibular advancement splints or conservative measures.
Over six months, patients in the primary and specialty care groups showed significant improvement in ESS score compared with baseline (mean decrease, 12.8 points to 7.0 points vs. 12.5 points to 7.0 points; P<0.001 for both comparisons). Management in primary care was found to be noninferior to management in specialty care (mean change in ESS score, 5.8 to 5.4; adjusted difference, −0.13; P=0.43). Secondary outcomes did not differ between the groups, but a larger proportion of patients withdrew from the study in the primary care group than in the specialty care group (21% vs. 8%).
The authors acknowledged that their results may not be generalizable to all patients with sleep apnea and that they could not determine why more patients from the primary care group withdrew from the study, among other limitations. However, they concluded that their results indicated noninferiority between primary and specialty care for sleep apnea.
“With adequate training of primary care physicians and practice nurses and with appropriate funding models to support an ambulatory strategy, primary care management of obstructive sleep apnea has the potential to improve patient access to sleep services,” the authors wrote.
They cautioned that their study results should not be extrapolated to settings where primary care physicians “may not be as skilled and motivated as those who participated in this randomized controlled trial and in which patient outcomes may not be as good as those observed in this study.” They also called for more research into the cost-effectiveness of a primary care approach.