Sleep Disorders |

The Optimal Use of Alternative Care Providers in the Treatment of Obstructive Sleep Apnea FREE TO VIEW

Anthony Dechant, MD; Diane Bischak, PhD; Patrick Hanly, MD; Willis Tsai, MD; Ann-Marie Stevenson, RRT; Sachin Pendharkar, MD
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University of Calgary, Calgary, AB, Canada

Chest. 2013;144(4_MeetingAbstracts):992A. doi:10.1378/chest.1701253
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SESSION TITLE: Sleep Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Alternative care providers (ACP) are an effective alternative to physician-based management of obstructive sleep apnea (OSA). The purpose of this study was to describe the clinical course of patients with OSA who were treated with continuous positive airway pressure (CPAP) and followed by ACPs. We postulated that a specific number of follow-up visits could be identified after which clinical outcomes no longer improved despite ongoing ACP follow-up.

METHODS: A prospective cohort study was undertaken at the Foothills Medical Centre (FMC) Sleep Centre. We included patients with a new diagnosis of uncomplicated OSA who initiated CPAP therapy and were referred by their sleep physician to an ACP for follow-up care. Epworth Sleepiness Scale (ESS) score was measured for each patient at baseline and at each ACP visit. We excluded patients with incomplete ESS data. Patients were discharged when they demonstrated an improvement in ESS and were adherent to CPAP. We analyzed the change in ESS over the course of ACP follow-up.

RESULTS: Complete ESS data was available for 474 patients. Of these, 156 patients had two visits, 26 had three visits and four had four visits. Patients with three or more visits were analyzed together. The mean age was 54 (95% CI ±2) years. Mean ESS score was 11.5 (95% CI ± 0.7) at baseline and 7.8 (95% CI ±0.7) at discharge. ESS scores at baseline and at discharge did not differ between patients with two visits and patients with three or more visits. The mean ESS score decreased by 3.7 points (95% CI ±0.86 points) for patients with two visits, and by 3.4 points (95% CI ±2.1 points) for patients with three or more visits. We could not identify a visit number after which no further improvements in ESS occurred despite ongoing follow-up.

CONCLUSIONS: Ongoing clinical care by ACPs leads to continued improvements in sleepiness in OSA patients treated with CPAP.

CLINICAL IMPLICATIONS: Our results suggest that some patients require longer follow-up to achieve clinical response to CPAP therapy. Identifying these patients may lead to improved resource utilization.

DISCLOSURE: The following authors have nothing to disclose: Anthony Dechant, Diane Bischak, Patrick Hanly, Willis Tsai, Ann-Marie Stevenson, Sachin Pendharkar

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