Management of obstructive sleep apnea through a multidisciplinary sleep clinic

Abstract

Purpose Obstructive sleep apnea (OSA) has become increasingly prevalent in recent years.1 The burden of the condition on the individual as well as the collective health care system has been well characterized and is primarily evidenced in the contribution of OSA to cardiovascular, metabolic, and psychiatric disorders.2 Management of OSA is often plagued by fragmentation of care among disarticulated individual providers, who may have expertise in certain aspects of the disease but often lack the comprehensive knowledge base necessary to adequately address all of its multifaceted intricacies.3 Collaboration among providers has proven critical to coordination of relevant diagnostic and treatment modalities across the array of medical specialists.4 The purpose of this study was to provide an example of how a multidisciplinary sleep clinic (MDSC) can optimize patient care by facilitating appropriate nonsurgical and surgical interventions through collaboration of relevant providers, namely, oral and maxillofacial surgeons, otolaryngologists, neurologists, and dentists. Methods This retrospective study reviewed the cases of 20 patients seen at the Virginia Commonwealth University Health System Multidisciplinary Sleep Clinic between April 2018 and April 2019. Patients were referred following diagnosis of OSA with intolerance to positive airway pressure management. Patients underwent baseline polysomnography and a variety diagnostic modalities. Based on the diagnostic workup, appropriate intervention was recommended for each patient. Recommendations included both nonsurgical management by the neurologist/dentist and surgical management by the oral and maxillofacial surgeon/otolaryngologist. Efficacy of the completed intervention was measured by using repeat polysomnography. Results Twenty patients were evaluated over 9 meetings during the year analyzed. Six completed diagnostic studies, were given management recommendations, and underwent their respective management modality with an average reduction of their Apnea Hypopnea Index (AHI) score from 34.5 to 14.4. Ten patients had pending surgical intervention, postintervention polysomnography/home sleep test, or continued diagnostic workup at the time of data query. Three patients had failed follow-up after surgical intervention was recommended. One patient withdrew from the study. Interventions completed and/or planned at the conclusion of the study included nonsurgical management (oral appliance therapy, modification to existing positive airway pressure device) and surgical management (septoplasty, turbinate reduction, adenoid ± lingual tonsil removal, uvulopalatopharyngoplasty, tongue base ± reduction, hypoglossal nerve stimulator implantation, hyoid suspension, and maxillomandibular advancement). Conclusion This retrospective study demonstrated that patient care can be facilitated through the collaboration of relevant providers in the management of OSA. All study patients who had completed the recommended interventions demonstrated successful reduction in AHI scores within 1 year of initial workup. Half of the population had ongoing workup, pending intervention, or incomplete repeat polysomnography at the conclusion of the study. This short duration and small patient population served as limitations. However, both limitations stem from the relatively short period in which the MDSC has been in operation at this institution. Within these limitations, the study provides a template upon which further research may be built. Future studies must be directed toward increased number of participants and length of follow-up, along with inclusion of subjective assessment of patient satisfaction with the collaborative approach and comparison of outcomes in patients undergoing management of OSA through individual providers versus providers within a collaborative setting.