Hospital sleep unit and primary care collaboration in diagnosis of respiratory sleep diseases: assessment of a six-year experience

Abstract

Respiratory sleep diseases (RSD) are one of the most frequent reasons for consultation at Hospital Sleep Units (HSU), and RSD high prevalence generates significant diagnostic waiting lists. The joint work with Primary Care (PC) according to a common protocol may be advisable to improve the care of these patients (P) and reduce health care costs. We aimed to evaluate the usefulness of a model of collaboration between a HSU with PC centers in the diagnosis of patients with suspected RSD. Between June 2006 and November 2012, 1531 p. (997 men and 534 women) were examined at 6 PC centers for suspected RSD. We previously agreed on a diagnostic circuit for these patients and a common working protocol. The PC physician, performed the 1st visit using a specific Form for RSD (F), that was sent by the health intranet to the HSU where a home sleep polygraphy at (PH).was scheduled. After the PH an HSU physician decided to conduct according to the protocols: (1) if Apnea Hypopnea Index (AHI) ⩾ 30 /h or AHI ⩾ 5 /h associated with risk work and/or severe drowsiness CPAP treatment was indicated and titrated and P subsequently visited with the HSU staff. (2) If protocol 1 criteria were not met, the study was technically poor, the P had not slept or if more sleep studies were required, P was sent to the HSU consultation to determine studies and treatment to perform. Clinical and study data were stored in an information database. 1361 PC PH were performed in the period studied. According the 1st protocol CPAP was indicated for 559 P, (58 P rejected it ) and 802 P followed the 2nd protocol: (1) 490 P ( 257 snorers and 233 Sleep Apnea Syndrome (SAS) light-moderate) did not require other studies and were referred to their PC doctor without CPAP. (2) 312 P required more sleep studies (polysomnography, Multiple Sleep Latency Test) and diagnosis was made: periodic limb movements 12 P, circadian rhythm disorders 9 P, narcolepsy 9 P, primary idiopathic, hypersomnia 10 P, snoring 21 P, and RSD 251 P [12 Upper Airway Resistance Syndrome ( 4 CPAP), 239 SAS (189 CPAP)]. The PC-HSU collaboration could solve and treat a significant percentage of consultations for suspected RSD (37–73%) without a previous visit by the HSU specialist. The HSU will ease the burden of care and serve a greater number of patients at a lower cost by coordinating with PC as well as manage patients with more complex RSD, CPAP adaptation problems or sleep disorders other than RSD. To Dr. Salvi Sendra.