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Type: Journal article
Title: How to assess, diagnose, refer and treat adult obstructive sleep apnoea: a commentary on the choices
Author: Mansfield, D.
Antic, N.
McEvoy, R.
Citation: Medical Journal of Australia, 2013; 199(8):S21-S26
Publisher: Australasian Medical Publishing Company Pty. Ltd.
Issue Date: 2013
ISSN: 1326-5377
Statement of
Darren R Mansfield, Nicholas A Antic and R Doug McEvoy
Abstract: Obstructive sleep apnoea (OSA) determined by polysomnography is highly prevalent, affecting about 25% of men and 10% of women in the United States, although most have few or no symptoms. Symptomatic moderate to severe OSA has major health implications related to daytime sleepiness, such as increased accidents, altered mood and loss of productivity in the workplace. Severe OSA may increase the risk of cardiovascular disease independent of daytime sleepiness. A major challenge is to correctly identify, from the large community pool of disease, people with symptoms and those at risk of long-term complications. For treatment plans to achieve quality patient outcomes, clinicians must have a clear understanding of patients’ symptoms and their motivations for presentation, and be knowledgeable about the evidence surrounding the health risks of OSA and the relative merits of the various diagnostic and treatment options available. The diagnosis of OSA represents a teachable moment to target adverse lifestyle factors such as excessive weight, excessive alcohol consumption and smoking, which may be contributing to OSA and long-term cardiometabolic risk. OSA assessment and management has traditionally involved specialist referral and in-laboratory polysomnography. However, these services may not always be easy to access. Controlled studies have shown that patients with a high pretest probability of symptomatic, moderate to severe OSA can be managed well in primary care, or by skilled nurses with appropriate medical backup, using simplified ambulatory models of care. The future of sleep apnoea assessment and management will likely include models of care that involve early referral to specialists of patients with complex or atypical presentations, and an upskilled and supported primary care workforce to manage symptomatic, uncomplicated, high pretest probability disease.
Keywords: Humans
Sleep Apnea, Obstructive
Weight Loss
Mass Screening
Monitoring, Ambulatory
Risk Factors
Cross-Sectional Studies
Patient Compliance
Life Style
Cost of Illness
Home Care Services
Referral and Consultation
Patient Care Planning
Patient Education as Topic
Rights: Copyright status unknown
DOI: 10.5694/mja13.10909
Appears in Collections:Aurora harvest
Medical Sciences publications

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