A Cheaper Choice for a Sleep Disorder

Obstructive sleep apnea patients get equally good treatment from GPs and specialists

(RxWiki News) If you think you might have obstructive sleep apnea, fear not if the wait for an appointment with a sleep doctor is taking too long. A primary care doctor may be just as helpful.

Patients with obstructive sleep apnea may receive just as good treatment from their primary care doctors as long as those doctors and their nurses are adequately trained, according to a small, unpublished study that was presented at a conference this week.

"See your doctor for any sleep issue as soon as possible."

Ching Li Chai-Coetzer, a doctor and researcher at the Adelaide Institute for Sleep Health at Repatriation General Hospital in Australia, and colleagues studied 155 patients who were randomly assigned to receive treatment at either a primary care center or by a sleep specialist.

After six months, the researchers measured how much the patients' level of sleepiness had changed based on an established assessment tool called the Epworth Sleepiness Scale.

This tool is scored from 0 to 24, with 24 meaning people are feeling especially sleepy in a variety of typical daily activities. The researchers found that the primary care group's score changed an average of 4.9 points on the scale, and the specialist group's average score dropped 5.1 on the scale - a negligible difference.

A different assessment tool, called the Functional Outcomes of Sleep Questionnaire, also produced a similar amount of change between the primary care group (2.3) and the specialist group (2.7).

The patients' compliance with using the treatment, called CPAP, was about the same in both groups as well: an average of 4.8 hours for patients of primary care doctors and 5.4 hours for patients of sleep specialists.

CPAP, or continuous positive airway pressure, is usually delivered through a mask worn by the patient. The mask pushes air into the person's airways to keep them open.

The primary care physicians diagnosed patients with moderate-to-severe obstructive sleep apnea using a four-question screening, the sleepiness scale, and a home unit called an oximeter, which measures the level of oxygen in a person's blood. Sleep specialists generally diagnosed patients based on a laboratory sleep study.

The study also revealed that the cost of care was about two-thirds lower for those who went to their primary care doctor. Because the study was conducted in Australia, this rate of savings may not be the same in the US, but it would still likely be far cheaper to see a primary care doctor than a sleep specialist in the US as well.

"This approach also offers a lower cost alternative to usual care. In addition, waiting lists for specialist sleep centers are long, and home care may be preferred by patients," said Dr. Chai-Coetzer.

The study was presented May 20 at the American Thoracic Society's 2012 International Conference in San Francisco. Because it is unpublished, other scientists have not reviewed it for a journal inclusion, and the data is still being analyzed, so it may change before potential publication.

The research was funded by the National Health and Medical Research Council of Australia. Information regarding possible conflicts of interest was not available.

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Review Date: 
May 23, 2012