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 “We found that in general, outcomes such as sleepiness, quality of
life, and treatment adherence were similar,” said senior study
author Dr. Timothy Wilt of the Minneapolis VA Healthcare System and
the University of Minnesota School of Medicine.
“Patients with daytime sleepiness could be adequately evaluated and
treated by primary care providers who have additional sleep
training, especially if access to sleep specialists is limited and
if there is unmet demand for sleep apnea services,” Wilt said by
email. “However, there is not yet sufficient evidence to support
widespread migration of sleep apnea care away from sleep
physicians.”
Millions of patients worldwide wear breathing masks all night to
ease sleep apnea, a common disorder that leads to disrupted
breathing or shallow breaths during sleep. The masks are connected
to a machine that provides continuous positive airway pressure (CPAP),
which splints the airway open with an airstream so the upper airway
can’t collapse during sleep.
Some patients who can’t tolerate wearing the breathing masks all
night may use an alternative apnea treatment known as mandibular
advancement devices, which open up space in the airway by pushing
out the lower jaw bone to make it less likely that the upper airway
collapses during sleep.
Apnea that isn’t properly treated has been linked with excessive
daytime sleepiness, decreased quality of life, heart attacks and
heart failure, researchers note in the Annals of Internal Medicine.
The current study set out to determine if primary care providers who
received additional training in diagnosing and treating sleep
disorders could manage apnea patients as well as specialists.
Apnea patients cared for by primary care providers had similar
outcomes for symptom relief, adherence to prescribed treatments and
quality of life as apnea patients seen by specialists, an analysis
of 8 previously published studies with a total of 1,515 patients
found.
Specialists and primary care providers also appeared to agree on the
diagnosis and severity of apnea, an analysis of four smaller studies
with a total of 580 patients found.
Researchers rated the quality of the evidence as low, however, and
concluded that more studies are still needed to confirm whether some
apnea patients could be treated without seeing specialists.
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Another limitation of the study is that even the primary care
providers still had extensive training in sleep medicine, making it
unclear if all apnea patients would get similar outcomes from their
own primary care provider, who might not have this training.
“Also, the studies reviewed were mostly done in obese, middle-aged
males with moderate-to-severe apnea,” said Marie-Pierre St-Onge, a
researcher at Columbia University Medical Center in New York City
who wasn’t involved in the study.
“It is not known if similar results would be seen in patients with
more complex cases or low probability for sleep apnea, women,
elderly, or those with (other chronic health problems) which are
quite prevalent in patients with sleep apnea,” St-Onge said by
email.
Still, the results do suggest that it may be possible to get an
accurate diagnosis of sleep apnea in primary care, noted Kristen
Knutson, a researcher at Northwestern University Feinberg School of
Medicine in Chicago who wasn’t involved in the study.
“If a patient is prescribed treatment for obstructive sleep apnea by
a non-specialist and it seems to be working for them, then they
probably don’t need to see a specialist,” Knutson said by email.
“However, if the treatment does not seem to work well, it is
uncomfortable, or they are still sleepy, then that patient could
consider a specialist who would have more experience with different
treatment options.”
SOURCE: http://bit.ly/2DMN3GA Annals of Internal Medicine, online
January 29, 2018.
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