Apnea outcomes may be similar when treated by sleep specialist or nonspecialist
Low-strength evidence indicated that outcomes were similar whether care was provided by primary care physicians, sleep specialist nurses, or sleep specialist physicians, although study authors noted that non–sleep specialists were often highly experienced in sleep medicine.
Patients with obstructive sleep apnea (OSA) can achieve similar outcomes with care from a sleep specialist or a nonspecialist, a systematic review found.
Researchers reviewed 12 published studies to evaluate the effectiveness and harms of care by clinicians who specialize in sleep disorders versus those who do not. The researchers assessed the studies to determine patient-centered outcomes (mortality, access to care, quality of life, patient satisfaction, adherence, symptom scores, and adverse events) and other outcomes, including resource use, costs, time to initiation of treatment, and case finding.
Results were published Jan. 30 by Annals of Internal Medicine.
Low-strength evidence indicated that outcomes were similar whether care was provided by primary care physicians, sleep specialist nurses, or sleep specialist physicians. Four observational studies (580 patients; mean age, 52 years; 77% male) reported good agreement between the two types of clinicians on appropriate diagnostic testing and classification of severity of obstructive sleep apnea (low-strength evidence). Five randomized trials and three observational studies (1,515 patients; mean age, 52 years; 68% male) found similar quality of life, adherence, and symptom scores in treated patients (low-strength evidence).
The evidence was insufficient to determine access to care or adverse events, the authors said. They noted that non–sleep specialists were often highly experienced in sleep medicine, that studies often were conducted in academic settings, and that the patients were most frequently obese men, so the results may not be generalizable to other settings and populations. The studies also did not provide clear details on how non-sleep specialists were trained or certified to provide obstructive sleep apnea case-finding and care.
“Future studies are needed to determine whether these results can be replicated in nonacademic settings and among primary care providers without extensive sleep medicine experience and how such care models should be implemented,” the authors wrote.