Primary Care Noninferior for Management of Sleep Apnea

Sleepiness scores no worse for treatment under primary care model versus specialist model
Primary Care Noninferior for Management of Sleep Apnea

WEDNESDAY, March 13 (HealthDay News) -- Management of obstructive sleep apnea in a primary care setting is noninferior to care at specialist sleep centers, according to a study published in the March 13 issue of the Journal of the American Medical Association.

Ching Li Chai-Coetzer, M.B.B.S., Ph.D., from Repatriation General Hospital in Australia, and colleagues randomized 155 patients with obstructive sleep apnea to receive treatment at primary care practices (81 patients) or to a university hospital sleep medicine center (74 patients). Treatment in both groups included continuous positive airway pressure, mandibular advancement splints, or conservative measures only. Six-month changes in the Epworth Sleepiness Scale (ESS) score were assessed, with a noninferiority margin set at −2.0.

The researchers found that both groups had significant improvements in ESS scores from baseline to six months. The mean baseline score decreased significantly from 12.8 to 7.0 in the primary care group and from 12.5 to 7.0 in the specialist group. The adjusted difference in the mean change in ESS score was −1.3, indicating that primary care management was noninferior to specialist management. There were no differences in disease-specific and general quality of life measures, obstructive sleep apnea symptoms, adherence to using continuous positive airway pressure, patient satisfaction, and health care costs between the groups.

"Among patients with obstructive sleep apnea, treatment under a primary care model compared with a specialist model did not result in worse sleepiness scores, suggesting that the two treatment modes may be comparable," write the authors.

Several authors disclosed financial ties to the medical device industry, including companies which manufacture products for the diagnosis and treatment of sleep-disordered breathing.

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