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|Issue 118||December 2016|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Obstructive Sleep Apnea: A Systematic Review
Obstructive sleep apnea (OSA) is a chronic condition that results from repeated closure of the upper airway during sleep that results in reduced airflow (hypopnea) or complete airflow cessation (apnea), which leads to cyclic sleep disruption. Patients with OSA frequently experience excessive daytime sleepiness and decreased quality of life. OSA also has been associated with a higher risk of myocardial infarction, heart failure, stroke, and cognitive decline. The estimated prevalence of mild to severe OSA in the United States (2007-2010 data) among 30- to 70-year-olds is 34% for men and 17% for women. Obesity is one of the major risk factors for OSA, and in 2010, among 1.8 million U.S. Veterans receiving outpatient care at 136 VA facilities, 37% had a body mass index (BMI) ≥ 30 kg/m2. These data suggest that a substantial number of Veterans are at increased risk for OSA. Moreover, VA and other healthcare systems often struggle to provide timely OSA diagnostic and treatment services, partially due to a rising demand for services, but also due to a declining pipeline of new sleep specialist physicians. To address this problem, some healthcare systems have sought to reduce reliance on sleep specialist physicians in the evaluation and treatment of patients with suspected or diagnosed OSA, through the use of non-sleep specialist practitioners, electronic consultation, and auto-titrating treatment devices.
This systematic review sought to assess the comparative effectiveness, harms, and costs of care models for OSA evaluation and treatment. Investigators with VA's Evidence-based Synthesis Program Center located in Minneapolis, Minnesota searched MEDLINE and CINAHL between January 2000 and May 2016. From this search, they identified eight reports (4 randomized controlled trials (RCTs) and 4 observational studies) that evaluated case-finding and care provided by non-sleep specialist practitioners versus sleep specialist physicians (SSP). Twenty-seven reports (25 RCTs and 2 observational studies) assessed in-home auto-titrating continuous positive airway pressure (APAP) technology versus standard continuous positive airway pressure (CPAP) titrated by in-lab polysomnogram (PSG) as options for PAP titration or treatment. Investigators used these data to address the following key questions for adults with suspected or diagnosed OSA:
Summary of Review
These future studies will be critical to effectively managing the dramatic increase in the numbers of patients being referred for evaluation and treatment of OSA.
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
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