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Title: Role of primary care in the follow-up of patients with obstructive sleep apnoea undergoing CPAP treatment: A randomised controlled trial
Authors: Sánchez-De-La-Torre, M.
Nadal, N.
Cortijo, A.
Masa, J. F.
Duran-Cantolla, J.
Valls, J.
Serra, S.
Sánchez-De-La-Torre, A.
Gracia, M.
Ferrer, F.
Lorente, I.
Urgeles, M. C.
Alonso, T.
Fuentes, A.
Armengol, F.
Lumbierres, M.
Vázquez-Polo, F. J. 
Barbé, F.
Keywords: Positive Airway Pressure
Polysomnography, et al
Issue Date: 2015
Publisher: 0040-6376
Journal: Thorax 
Abstract: Objective To evaluate whether follow-up of patients with obstructive sleep apnoea (OSA) undergoing CPAP treatment could be performed in primary care (PC) settings.Design Non-inferiority, randomised, prospective controlled study.Settings Sleep unit (SU) at the University Hospital and in 8 PC units in Lleida, Spain.Participants Patients with OSA were randomised to be followed up at the SU or PC units over a 6-month period.Main outcomes measured The primary outcome was CPAP compliance at 6 months. The secondary outcomes were Epworth Sleep Scale (ESS) score, EuroQoL, patient satisfaction, body mass index (BMI), blood pressure and cost-effectiveness.Results We included 101 patients in PC ((mean +/- SD) apnoea-hypopnoea index (AHI) 50.8 +/- 22.9/h, age 56.2 +/- 11 years, 74% male) and 109 in the SU (AHI 51.4 +/- 24.4/h, age 55.8 +/- 11 years, 77% male)). The CPAP compliance was (mean (95% CI) 4.94 (4.47 to 5.5) vs 5.23 (4.79 to 5.66) h, p=0.18) in PC and SU groups, respectively. In the SU group, there were greater improvements in ESS scores (mean change 1.79, 95% CI +0.05 to +3.53, p=0.04) and patient satisfaction (-1.49, 95% CI -2.22 to -0.76); there was a significant mean difference in BMI between the groups (0.57, 95% CI +0.01 to +1.13, p=0.04). In the PC setting, there was a cost saving of 60%, with similar effectiveness, as well as a decrease in systolic blood pressure (-5.32; 95% CI -10.91 to +0.28, p=0.06).Conclusions For patients with OSA, treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative.
ISSN: 0040-6376
DOI: 10.1136/thoraxjnl-2014-206287
Source: Thorax[ISSN 0040-6376],v. 70, p. 346-352
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