Primary care professionals need to be more actively engaged in the management of obstructive sleep apnoea if the unmet burden of disease is to be addressed, says Professor Doug McEvoy and colleagues from the Adelaide Institute for Sleep Health.
In a comment published in Lancet Respiratory Medicine timed to coincide with the European Respiratory Society’s Sleep and Breathing Conference the authors say the high prevalence of obstructive sleep apnoea (OSA) has led to long waiting times to see a sleep specialist in some health care systems.
This had led their group (and others) to consider a greater role for primary care physicians, nurses, and other health professionals in the management of OSA.
“Ideally this uses a hub-and-spoke model, in which OSA is managed predominantly in the community, with support for patients with more complicated or treatment-resistant symptoms provided in a sleep medicine centre,” they wrote.
In a randomised study they conducted at their centre primary care physicians identified patients with moderate to severe OSA using a validated, two-step diagnostic strategy of the OSA50.
After six months primary care management was found to be non-inferior to specialist management in a whole range of outcomes, and per patient costs were 38% less in the primary care arm of the study.
These results, together with those from other studies, suggest that primary care physicians, practice nurses, and potentially pharmacists can assist in the diagnosis and management of OSA if they are adequately trained and resourced.
“We believe that a more active engagement of primary care professionals in the management of OSA is necessary to address the unmet burden of disease,” they concluded.