Some 155 patients aged 25 to 70 years with sleep apnoea were randomised to receive either management in primary care or in a specialised sleep centre. All patients were deemed to have a high diagnostic likelihood of moderate to severe sleep apnoea, defined as a score of five or more on a four-item screening questionnaire and an overnight 3% oxygen desaturation index of at least 16 events per hour. Primary care management consisted of advice on managing continuous positive airway pressure (CPAP)-related adverse effects, encouragement to maintain adherence and education about lifestyle changes to improve sleep apnoea. Specialist centres also had a patient’s overnight oximetry trace and further investigations if necessary.
Mean Epworth Sleepiness Scale (ESS) scores for the primary care group improved from 12.8 to 7.0 after six months, and in the specialist group from 12.5 to 7.0. The adjusted difference in the mean change in ESS score was not significant between the two groups. Improvements were also present in both groups for the Functional Outcomes of Sleep Questionnaire, but there was no significant difference between the two groups for the change from baseline to six months. The estimated costs per patient for primary care were £1,217, compared with £2,052 in the specialised care group.
What does it mean for GPs?
The Australian authors concluded that ‘with adequate training of primary care physicians and practice nurses and with appropriate funding models to support an ambulatory strategy, primary care management of obstructive sleep apnoea has the potential to improve patient access to sleep services.’