Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
ICES, Ottawa, Toronto, Ontario, Canada.
BMJ Open Respir Res. 2024 Aug 25;11(1):e002476. doi: 10.1136/bmjresp-2024-002476.
Following marked reductions in sleep medicine care early in the COVID-19 pandemic, there is limited information about the recovery of these services. We explored long-term trends in obstructive sleep apnoea (OSA) health services and service backlogs during the pandemic compared with pre-pandemic levels in Ontario (the most populous province of Canada).
In this retrospective population-based study using Ontario (Canada) health administrative data on adults, we compared rates of polysomnograms (PSGs), outpatient visits and positive airway pressure (PAP) therapy purchase claims during the pandemic (March 2020 to December 2022) to pre-pandemic rates (2015-2019). We calculated projected rates using monthly seasonal time series auto-regressive integrated moving-average models based on similar periods in previous years. Service backlogs were estimated from the difference between projected and observed rates.
Compared with historical data, all service rates decreased at first during March to May 2020 and subsequently increased. By December 2022, observed service rates per 100 000 persons remained lower than projected for PSGs (September to December 2022: 113 vs 141, 95% CI: 121 to 163) and PAP claims (September to December 2022: 50 vs 60, 95% CI: 51 to 70), and returned to projected for outpatient OSA visits. By December 2022, the service backlog was 193 078 PSGs (95% CI: 139 294 to 253 075) and 57 321 PAP claims (95% CI: 27 703 to 86 938).
As of December 2022, there was a sustained reduction in OSA-related health services in Ontario, Canada. The resulting service backlog has likely worsened existing problems with underdiagnosis and undertreatment of OSA and supports the adoption of flexible care delivery models for OSA that include portable technologies.
在 COVID-19 大流行初期，睡眠医学服务大幅减少，目前关于这些服务恢复情况的信息有限。我们探讨了大流行期间与大流行前相比（加拿大人口最多的安大略省）阻塞性睡眠呼吸暂停（OSA）健康服务和服务积压的长期趋势。
在这项使用安大略省（加拿大）成年人健康管理数据的回顾性基于人群的研究中，我们比较了大流行期间（2020 年 3 月至 2022 年 12 月）与大流行前（2015-2019 年）多导睡眠图（PSG）、门诊就诊和正压通气（PAP）治疗购买申请的发生率。我们使用基于前几年类似时期的月度季节性时间序列自回归综合移动平均模型来计算预测发生率。服务积压是根据预测和观察到的比率之间的差异来估计的。
与历史数据相比，所有服务的使用率在 2020 年 3 月至 5 月期间首先下降，随后增加。到 2022 年 12 月，每 100 000 人观察到的服务使用率仍低于 PSG（2022 年 9 月至 12 月：113 比 141，95%CI：121 至 163）和 PAP 索赔（2022 年 9 月至 12 月：50 比 60，95%CI：51 至 70）的预测值，而门诊 OSA 就诊的服务使用率则恢复到预测值。到 2022 年 12 月，服务积压为 193 078 张 PSG（95%CI：139 294 至 253 075）和 57 321 张 PAP 索赔（95%CI：27 703 至 86 938）。
截至 2022 年 12 月，加拿大安大略省与 OSA 相关的健康服务持续减少。由此产生的服务积压可能使 OSA 诊断不足和治疗不足的现有问题恶化，并支持采用包括便携式技术在内的灵活 OSA 护理提供模式。
