Diagnostic pathways for obstructive sleep apnoea in the Australian community: observations from pharmacy-based CPAP providers

Hanes, Carissa A.; Wong, Keith; Saini, Bandana

doi:10.1007/s11325-015-1151-9

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Model C AUC (solid line), PPV (blue dashed line) and NPV (red dotted line) at four thresholds 5,10,15,26 for the PSG AHI, in the development population. AHI, apnoea–hypopnoea index; AUC, area under the curve; NPV, negative predictive value; PPV, positive predictive value; PSG, polysomnography…”

Section: Resultsmentioning

confidence: 99%

“…This is the first study to develop a diagnostic model for OSA which considers the clinical impressions of the PCP, closely emulating a routine clinical referral pathway. A singlechannel device, along with demographic and clinical F I G U R E 3 Model C AUC (solid line), PPV (blue dashed line) and NPV (red dotted line) at four thresholds 5,10,15,26 for the PSG AHI, in the development population. AHI, apnoea-hypopnoea index; AUC, area under the curve; NPV, negative predictive value; PPV, positive predictive value; PSG, polysomnography characteristics easily obtained during a primary care consultation, can predict the presence of in-laboratory PSG determined OSA.…”

Section: Discussionmentioning

confidence: 99%

“…Some alternative models of care are already in use, despite limited evidence of their validity. 10 Moreover, accurate diagnosis of OSA is important given that it may impact on driver licensing, employment or life insurance.…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines still recommend full PSG where available, 7 but a simplified and more streamlined method of diagnosis is required to ensure that the demand for OSA diagnostic services is met. Some alternative models of care are already in use, despite limited evidence of their validity 10 . Moreover, accurate diagnosis of OSA is important given that it may impact on driver licensing, employment or life insurance.…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care

et al. 2021

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Background and objective: Use of in-laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care. Methods: Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single-channel nasal flow monitor (Flow Wiz-ard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in-laboratory PSG was the reference test, with OSA defined as apnoea-hypopnoea index (AHI) ≥10 events/h. Results: In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53-0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients. Conclusion: Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes. K E Y W O R D S development and validation, diagnostic model, obstructive sleep apnoea, predictive value, primary care † List of collaborator names are given in the Acknowledgements.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care

et al. 2021

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A systematic review of pharmacists performing obstructive sleep apnea screening services

Cawley

Warning

2016

Int J Clin Pharm

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Background Obstructive sleep apnea (OSA) is a chronic sleep disorder associated with a varying degree of upper airway collapse during sleep. Left untreated, OSA can lead to the development of cardiovascular disease including risk of stroke and increased mortality. Pharmacists are the most accessible and underutilized healthcare resource in the community and can have a significant role in screening patients for OSA. The result may include an expedited referral to the patient's general practitioners or sleep disorder specialists for further diagnostic assessment and therapeutic intervention. Aim of the review The primary aim of this review was to identify the current published evidence of pharmacists providing OSA screening services in a community pharmacy setting. Methods A literature search was conducted to identify evidence of pharmacists providing OSA screening services. The literature search including five databases [PubMed, (1946-January 2015), Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts (1970 to January 2015), Cochrane Database of Systematic Reviews and Google Scholar] with search terms of ("pharmacist or pharmacy") AND ("obstructive sleep apnea") AND ("sleep disorders") AND ("continuous positive airway pressure-CPAP") were used. Articles were limited to English and reported in humans. Results A total of seven publications (four Australia, two Switzerland and one France) were selected and evaluated. Pharmacists utilized validated screening tools in 6/7 (86 %) of clinical studies to assist in the identification of patients with sleep disorders in community pharmacies. A total of 1701 pharmacies encompassing 9177 patients were screened in the clinical studies. Pharmacists were able to identify between 21.4 and 67 % of patients that were at risk for developing OSA or required a referral to a general practitioner or sleep disorder specialist for further diagnostic testing. Conclusion Studies assessing the role of pharmacists performing OSA screening services remains limited due to the small number of studies available and differences in methodological assessment. More qualitative studies including randomized controlled trials are needed to better identify the value of pharmacists providing this novel service.

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The Impact of Telehealth on the Organization of the Health System and Integrated Care

O’Donnell

Ryan

McNicholas

2020

Sleep Medicine Clinics

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Diagnostic pathways for obstructive sleep apnoea in the Australian community: observations from pharmacy-based CPAP providers

Abstract: Diagnostic models have evolved in Australia that raise stakeholder concerns. It is important to address these concerns while still facilitating patient access to services. Development of a practice framework could promote medically appropriate, patient-centred care.

Cited by 7 publications

References 22 publications

Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care

Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care

A systematic review of pharmacists performing obstructive sleep apnea screening services

The Impact of Telehealth on the Organization of the Health System and Integrated Care

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