Patients with Sleep Apnea Achieve Similar Outcomes From Sleep Specialist or Nonspecialist

Sleep Review Magazine ^ | January 30, 2018

[nickcarraway]

Systematic Review: Patients with Sleep Apnea Achieve Similar Outcomes When Receiving Care From Sleep Specialist or Nonspecialist

Patients with obstructive sleep apnea (OSA) can achieve similar outcomes with care from a sleep specialist or a non-sleep specialist. The findings of a systematic review are published in Annals of Internal Medicine.

New treatment models have been proposed that would reduce reliance on sleep specialists by including providers not specifically trained as sleep specialists, such as nurses or primary care physicians.

Researchers from the Minneapolis Veterans Affairs Health Care System Evidence-based Synthesis Program and the University of Minnesota, School of Medicine reviewed 12 published studies to evaluate the effectiveness and harms of care by non-sleep specialists versus sleep specialists for patients with suspected or diagnosed OSA. 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. The data showed low-strength evidence that OSA management outcomes are similar whether provided by primary care physicians, sleep specialist nurses, or sleep specialist physicians. The evidence was insufficient to assess for access to care or adverse events.

The researchers suggest more research to confirm these findings in other settings and among providers with different levels of experience and training and to determine how such care models should be implemented.

[FrogMom]

I had a stroke almost 5 years ago, now. Doctor said one of my big risk factors was my OSA.

I have a couple of friends who “can’t bring themselves to wear the Darth Vader mask”. I’m afraid NOT to wear it.

[Eagles6]

My Dad(91) couldn't get used to CPAP.

Long story but he uses O2 with a nasal cannula while sleeping.

Saved his life and his sanity...and ours.

[nickcarraway]

Did he ever try EPAP?

[Eagles6]

Couldn't get BPAP or anything else approved.

IT HAS DONE WONDERS!

[OrangeHoof]

The researchers suggest more research

Wow...I'm just shocked! More research! So who's going to pay for that?

[unlearner]

Non-specialists are more likely to prescribe sleeping medicine that is not recommended for OSA.

OSA causes sleep problems, but the underlying cause of oxygen deprivation must be addressed safely. Otherwise, it can lead to strokes or heart attacks.

Usually this means using positive air pressure during at least some (REM) seep.

Some people permanently recover via weight loss.

In extreme cases, a tracheotomy may be required.

[unlearner]

Is his O2 supplied with positive air pressure?

I’ve heard of people combining O2 with a CPAP or equivalent for OSA.

[Eagles6]

Strictly positive pressure O2 with nasal cannula. I’ll give you more info later

[Rad_J]

Putting the upper part of our bed at a slight incline has helped my wife and I the most. Plus it significantly reduced our snoring. Amazing.

This can be done with an adjustable bed or a 3 foot by 2 1/2 foot piece of plywood under the mattress at an angle.

[GnuThere]

Sleep apnea medicine has become a gravy train for “specialists” to interpret studies that are basically a computer printout that could be sent to one’s PCP.

[wally_bert]

I’ve been on cpap for a couple of years now, it has made a big difference.

[\/\/ayne]

I had radiofrequency ablation and uvula removed 20 years ago to no avail. The doctor had said it had over 90% effectiveness. Years later another doctor said it was much less. The first doctor had left town not long after the surgery.

Been using a CPAP for many years but recently found out I'm snoring loudly even with that and raising the upper body. I tried little nostril openers but they didn't work, just ordered a chin strap to hold my mouth closed.

[spintreebob]

I know some politicians who can put me to sleep with no training

[jjsheridan5]

In extreme cases, a tracheotomy may be required.

I have never heard of this. As far as my research goes, the *only* surgical approach which really works is Maxillo Mandibular Advancement surgery (this is the surgery performed on then-Cleveland Indians 1st baseman Mike Napoli). Originally part of the so-called "Stanford Protocol" (the gold standard of surgical approaches to apnea), it has since become the gold-standard on its own, since the UPPP surgery (part of the Stanford Protocol) was found to be problematic, and unnecessary in any case). But a "tracheotomy"? I have never heard of this. Do you mean a UPPP? In which case, studies have been pretty definitive that even if there is a benefit, it is generally minor, and, unfortunately, goes away over time.

[central_va]

I lost 50 pounds. The apnea went away. So did my sore back and knee. No secret here.

[jjsheridan5]

See my prior post. UPPP (and all parts of UPPP) are really inadvisable. Find a sleep doctor who keeps up with the latest research. The *only* surgery a person should even consider is the advancement surgery, at least according to research I have done.

But, as far as CPAP goes: there was a big study that came out recently which confirmed what my cardiologist told me off-the-record. CPAP (and other positive airway devices) may reduce snoring, and reduce patient sleeplessness, they have no appreciable effect on any of the apnea-related issues, including cardiac issues.

Once again, find a doctor who really keeps up with this changing field. Many doctors will simply prescribe CPAP as a matter of course, but there is a real question as to whether this is really effective.

[TiGuy22]

Me too, huge difference.

But to the point of the article, when I have an appointment I spend 90%+ of my time with a trained tech who is not a doctor. He evaluates my results, consults, and cand set the pressure of my machine. Doctor comes in at the end but it seems like a waste. I can see if someone had pulmonary issues, but I’d guess most cases don’t.

[jjsheridan5]

I lost 50 pounds. The apnea went away. So did my sore back and knee. No secret here.

Because apnea was always associated (incorrectly, and as you have done) with obesity, most serious cases of apnea went undetected. Yes, there are some people who can deal with apnea through weight loss. They are the lucky ones. Everybody else isn't so lucky. That is the real "secret" -- non-obesity related apnea is much more common than once thought, and infinitely more difficult to treat.

[jjsheridan5]

I’ve been on cpap for a couple of years now, it has made a big difference.

You may want to look at recent studies. It appears that CPAP has no real effect on the *effects* of sleep apnea, although it can improve quality of life, in some cases. Unfortunately, we are still very early in the process of understanding sleep apnea, and dealing with it effectively. Contradictory and paradoxical studies abound.