Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of lIfe: a randomized trial

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dc.contributor.authorChai-Coetzer, C.
dc.contributor.authorAntic, N.
dc.contributor.authorRowland, L.
dc.contributor.authorReed, R.
dc.contributor.authorEsterman, A.
dc.contributor.authorCatcheside, P.
dc.contributor.authorEckermann, S.
dc.contributor.authorVowles, N.
dc.contributor.authorWilliams, H.
dc.contributor.authorDunn, S.
dc.contributor.authorMcEvoy, R.
dc.date.issued2013
dc.description.abstractImportance: Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea. With appropriate training and simplified management tools, primary care physicians are ideally positioned to take on a greater role in diagnosis and treatment. Objective: To compare the clinical efficacy and within-trial costs of a simplified model of diagnosis and care in primary care relative to that in specialist sleep centers. Design, Setting, and Patients: A randomized, controlled, noninferiority study involving 155 patients with obstructive sleep apnea that was treated at primary care practices (n=81) in metropolitan Adelaide, 3 rural regions of South Australia or at a university hospital sleep medicine center in Adelaide, Australia (n = 74), between September 2008 and June 2010. Interventions: Primary care management of obstructive sleep apnea vs usual care in a specialist sleep center; both plans included continuous positive airway pressure, mandibular advancement splints, or conservative measures only. Main Outcome and Measures: The primary outcome was 6-month change in Epworth Sleepiness Scale (ESS) score, which ranges from 0 (no daytime sleepiness) to 24 points (high level of daytime sleepiness). The noninferiority margin was −2.0. Secondary outcomes included 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. Results: There were significant improvements in ESS scores from baseline to 6 months in both groups. In the primary care group, the mean baseline score of 12.8 decreased to 7.0 at 6 months (P < .001), and in the specialist group, the score decreased from a mean of 12.5 to 7.0 (P < .001). Primary care management was noninferior to specialist management with a mean change in ESS score of 5.8 vs 5.4 (adjusted difference, −0.13; lower bound of 1-sided 95% CI, −1.5; P = .43). There were no differences in secondary outcome measures between groups. Seventeen patients (21%) withdrew from the study in the primary care group vs 6 patients (8%) in the specialist group. Conclusions and Relevance: 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 2 treatment modes may be comparable.
dc.description.statementofresponsibilityChing Li Chai-Coetzer, Nick A. Antic, Sharn Rowland, Richard L. Reed, Adrian Esterman, Peter G. Catcheside, Simon Eckermann, Norman Vowles, Helena Williams, Sandra Dunn and R. Doug McEvoy
dc.identifier.citationJournal of the American Medical Association (JAMA), 2013; 309(10):997-1004
dc.identifier.doi10.1001/jama.2013.1823
dc.identifier.issn1538-3598
dc.identifier.issn1538-3598
dc.identifier.orcidEsterman, A. [0000-0001-7324-9171]
dc.identifier.orcidCatcheside, P. [0000-0002-9372-6788]
dc.identifier.orcidMcEvoy, R. [0000-0002-5759-0094]
dc.identifier.urihttp://hdl.handle.net/2440/82939
dc.language.isoen
dc.publisherAmerican Medical Association
dc.rights© 2013 American Medical Association. All Rights Reserved.
dc.source.urihttps://doi.org/10.1001/jama.2013.1823
dc.subjectHumans
dc.subjectSleep Apnea, Obstructive
dc.subjectTreatment Outcome
dc.subjectContinuous Positive Airway Pressure
dc.subjectSeverity of Illness Index
dc.subjectMedicine
dc.subjectQuality of Life
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectRural Population
dc.subjectHospitals, University
dc.subjectAmbulatory Care Facilities
dc.subjectHealth Care Costs
dc.subjectPrimary Health Care
dc.subjectAustralia
dc.subjectFemale
dc.subjectMale
dc.titlePrimary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of lIfe: a randomized trial
dc.typeJournal article
pubs.publication-statusPublished

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