Coordinated program between primary care and sleep unit for the management of obstructive sleep apnea

Mercè Mayos,Gabriel Sampol,M Antònia Llauger,Xavier Flor,Patricia Lloberes,Joan Bayó,José Ignacio Aoiz,Patricia Peñacoba,Núria Grau,Joan Juvanteny,Anna María Pedro Pijoan,Carme Santiveri,Ana M Fortuna,Vicente Plaza

doi:10.1038/s41533-019-0151-9

Abstract

The purpose of this study is to develop and validate a work model in the primary health-care setting for identifying patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) based on clinical variables and an ambulatory sleep monitoring study. After screening, patients with mild–moderate OSAHS could be managed by primary care physicians, whereas those identified with severe OSAHS would be referred to specialists from sleep units for starting specific treatment. The proposed model does not move the entire health-care process to a generally overburdened primary care level and favors the coordinated work and the necessary flexibility to adapt the model to challenges and perspectives of OSAHS.

Highlights

Obstructive sleep apnea–hypopnea syndrome (OSAHS) is a common breathing disorder in the general population,[1] with major clinical and socioeconomic consequences.[2]
Daytime sleepiness is a cardinal symptom of OSAHS and if left untreated, it leads to cognitive dysfunction, decrements in health-related quality of life, impaired work performance, and increased risk for accidents in the workplace and traffic accidents.[3,4]
continuous positive airway pressure (CPAP) is highly effective in controlling obstructive respiratory events, improvement of symptoms and quality of life of patients affected with OSHAS,[12] and significant reduction of blood pressure[13,14] and insulin resistance.[15]

Summary

INTRODUCTION

Obstructive sleep apnea–hypopnea syndrome (OSAHS) is a common breathing disorder in the general population,[1] with major clinical and socioeconomic consequences.[2]. Daytime sleepiness is a cardinal symptom of OSAHS and if left untreated, it leads to cognitive dysfunction, decrements in health-related quality of life, impaired work performance, and increased risk for accidents in the workplace and traffic accidents.[3,4] repetitive episodes of hypoxia and enhanced sympathetic activity trigger pathogenic pathways related to an increased risk for cardiovascular and metabolic morbidity[5,6,7,8] and mortality.[9,10]. It has been argued that primary care physicians have to assume a central role in the care of patients with OSAHS, which simplifies excessively the management of patients with an increasingly complex disease.[25]

AIMS

Findings

Design and participants