Abstract
BackgroundThe coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting.MethodsAnthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed.Results194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763–0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863–0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7–92.1) and specificity of 67.8% (95% CI 55.1–78.3).ConclusionsThe use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment.Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979. Date of registration: October 30, 2015.
Highlights
The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA)
Exclusion criteria were as follows: previous diagnosis of OSA, chronic insomnia (< 5 h of sleep/day), cognitive impairment or psychophysical inability to perform the home sleep apnea test (HSAT), acute or unstable cardiovascular or cerebrovascular disease, neuromuscular disease, moderate-to-severe chronic obstructive pulmonary disease (COPD) (FEV1/ Forced vital capacity (FVC) < 0.7% and Forced expiratory volume in 1 s (FEV1) < 50% predicted), and relevant respiratory comorbidity that may interfere with arterial blood saturation measurements
There were no significant differences between patients with low clinical probability of OSA based on scoring of the Berlin questionnaire that were randomized to or not to perform a HSAT (Table S1, Supplementary material)
Summary
The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The participation of primary care professionals may contribute to improve underdiagnosis of OSA [8], which is relevant because of conclusive evidence of the beneficial effects of continuous positive airway pressure (CPAP) on the overall health and prognosis of the patients [9]. In this context, primary care professionals play a double role. The ideal model probably includes a coordinated network between different levels of care, adapted to the health care characteristics of the region and workload of the different settings, and able to be applicable to the broad spectrum of OSA phenotypes
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