12 March 2009
A simpler, less costly method of diagnosing and treating obstructive sleep apnea (OSA) is as effective as the traditional protocol that relies on specialist physicians and sleep studies, according to Australian researchers.
People with OSA experience 20 to 30 or more breathing interruptions an hour while they sleep. The condition, which may affect as many as 20 million to 30 million American adults, can cause cardiovascular problems, hypertension and other health issues. Daytime drowsiness caused by OSA also increases the risk of traffic crashes and workplace accidents.
In a study of almost 200 people with moderate to severe OSA, the Australian team compared the simplified diagnosis and treatment approach, which uses experienced nurses, home ambulatory diagnosis and auto-titrating continuous positive airway pressure (CPAP) machines, to the traditional approach.
People in the nurse-led group had an average of 0.18 physician consultations, compared with an average of 2.36 consultations in the physician-led group. There were no significant differences in outcomes, including levels of sleepiness, quality of life measures, ability to do maze tasks and CPAP adherence.
Diagnosis and treatment of people in the nurse-led group cost an average of $722 less than it did in the physician-led group.
"The main finding of the study was that the simplified model of care was not inferior to the usual physician-led, hospital-based model," Nick A. Antic, of the Adelaide Institute for Sleep Health, said in an American Thoracic Society news release.
"While we were not surprised at this finding, we were very pleased as it indicates a robust new avenue for providing better access to sleep services for those with moderate-severe OSA in a timely yet cost-effective fashion without sacrificing patient outcomes," he said.
The study, published in the second issue for March of the American Journal of Respiratory and Critical Care Medicine, suggested that this simplified method could improve access to OSA diagnosis and treatment.
"In Western countries, the waiting lists for sleep medicine service are often very long," Antic said. "In developing countries, there may be no sleep medicine services at all in many areas."
Edward Grandi, executive director of the American Sleep Apnea Association, said in the news release that the "approach could benefit a significant number of the less-complicated apnea cases that are currently untreated due to cost constraints."
This article was first published in www.nlm.nih.gov