Peñacoba Patricia, Llauger M Antònia, Fortuna Ana M, Flor Xavier, Sampol Gabriel, Pedro Pijoan Anna Maria, Grau Núria, Santiveri Carme, Juvanteny Joan, Aoiz José Ignacio, Bayó Joan, Lloberes Patricia, Mayos Mercè
Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Clin Sleep Med. 2020 Sep 15;16(9):1579-1589. doi: 10.5664/jcsm.8492.
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.
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.
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.
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.
Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.
基层医疗团队参与阻塞性睡眠呼吸暂停（OSA）患者的护理是一个备受关注的焦点。本研究的目的是比较基层医疗专业人员和睡眠科专家所做决策之间的诊断和治疗一致性。
这是一项在西班牙巴塞罗那市区的基层医疗和专科护理中心进行的前瞻性多中心研究。招募了因任何原因前往参与研究的基层医疗中心就诊的18 - 75岁的男性和女性。基层医疗医生和睡眠专家都根据临床数据和家庭睡眠呼吸暂停测试结果做出诊断和治疗决策。所有患者最终都接受了呼吸多导睡眠图或多导睡眠图检查作为金标准测试。
共有229名患者接受了家庭睡眠呼吸暂停测试，并在基层医疗中心和睡眠科进行了评估。使用相同工具且排除不确定决策后的诊断一致性为69.8%（Cohen's kappa = 0.64；95%置信区间，0.56 - 0.72）。82.5%的患者在治疗决策（持续气道正压通气治疗与保守治疗）上达成一致（Cohen's kappa = 0.62；95%置信区间，0.51 - 0.73），排除不确定选项后这一比例增至92.5%（Cohen's kappa = 0.49，95%置信区间，0.40 - 0.58）。与睡眠科根据呼吸多导睡眠图/多导睡眠图做出的最终治疗决策相比，基层医疗医生对83.3%的患者达成了一致（Cohen's kappa = 0.62；95%置信区间，0.49 - 0.74）。
基层医疗专业人员在与睡眠中心协作管理OSA方面可能发挥重要作用，识别需要特定治疗并应转诊至专科护理的患者。
注册机构：ClinicalTrials.gov；名称：PASHOS项目：睡眠呼吸暂停综合征评估高级平台；网址：https://clinicaltrials.gov/ct2/show/NCT02591979；标识符：NCT02591979。
