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Multicenter Study
. 2020 Sep 15;16(9):1579-1589.
doi: 10.5664/jcsm.8492.

Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain

Patricia Peñacoba  1   2 , M Antònia Llauger  2   3 , Ana M Fortuna  1   2 , Xavier Flor  2   4 , Gabriel Sampol  2   5   6 , Anna Maria Pedro Pijoan  7 , Núria Grau  6   8 , Carme Santiveri  9 , Joan Juvanteny  2   10 , José Ignacio Aoiz  11 , Joan Bayó  11 , Patricia Lloberes  5   6 , Mercè Mayos  1   2   6 ; PASHOS Working Group
Affiliations
Multicenter Study

Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain

Patricia Peñacoba et al. J Clin Sleep Med. .

Abstract

Study objectives: Involvement of primary care teams in the care of patients with OSA is a focus of interest. The study objective was to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists.

Methods: This was a prospective multicenter study conducted at primary care and specialized care centers in the urban area of Barcelona, Spain. Men and women aged 18-75 years who visited the participating primary care centers for any reason were recruited. Both primary care physicians and sleep specialists made a diagnostic and therapeutic decision with clinical data and results of a home sleep apnea test. All patients were finally assessed with respiratory polygraphy or polysomnography as a gold-standard test.

Results: A total of 229 patients underwent a home sleep apnea test and were evaluated at the primary care centers and the sleep units. Diagnostic agreement using the same tools and excluding indeterminate decisions was 69.8% (Cohen's kappa = 0.64; 95% confidence interval, 0.56-0.72). Agreement for therapeutic decisions (PAP vs conservative treatment) was obtained in 82.5% of patients (Cohen's kappa = 0.62; 95% confidence interval, 0.51-0.73), increasing to 92.5% (Cohen's kappa = 0.49, 95% confidence interval, 0.40-0.58) when indeterminate options were excluded. As compared with the final therapeutic decisions made at the sleep unit with respiratory polygraphy/polysomnography, primary care physicians agreed regarding 83.3% (Cohen's kappa = 0.62; 95% confidence interval, 0.49-0.74) of patients.

Conclusions: Primary care professionals may assume an important role in the management of OSA in coordination with sleep centers, identifying patients who require specific treatment and should be referred to specialized care.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.

Keywords: primary care; sleep apnea; sleep unit.

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Figures

Figure 1
Figure 1. Flowchart of the study population.
HSAT = home sleep apnea test, PSG = polysomnography, RP = respiratory polygraphy.
Figure 2
Figure 2. Agreement for diagnostic decisions.
In light blue, concordant patients; in red, no concordant patients. The size of the circle represents the proportion of patients. (A) Agreement between primary care and sleep units based on HSAT. (B) Agreement between sleep units based on RP/PSG and primary care based on HSAT. (C) Agreement at sleep unit based on RP/PSG and HSAT. HSAT = home sleep apnea test, PSG = polysomnography, RP = respiratory polygraphy.
Figure 3
Figure 3. Agreement for therapeutic decisions.
In light blue, concordant patients; in red, no concordant patients. The size of the circle represents the proportion of patients. (A) Agreement between primary care and sleep units based on HSAT. (B) Agreement between sleep units based on RP/PSG and primary care based on HSAT. (C) Agreement at sleep unit based on RP/PSG and HSAT. HSAT = home sleep apnea test, PSG = polysomnography, RP = respiratory polygraphy.
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