Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality of LifeA Randomized Trial

OBSTRUCTIVE SLEEP APNEA with accompanying daytime sleepiness was estimated during the early 1990s to affect between 2% and 4% of middle-aged adults. With growing awareness of the public health implications of untreated disease and rising obesity rates that have increased the prevalence of obstructive sleep apnea, there has been a steady demand for sleep service provision in specialist centers and growing waiting lists for sleep physician consultation and laboratory-based polysomnography (PSG). As a result, there has been increasing interest in the use of screening questionnaires, home sleep monitoring, and autotitrating continuous positive airway pressure (CPAP), and greater involvement of other health care professionals in providing care. One-third of primary care patients report symptoms suggestive of obstructive sleep apnea. With appropriate training and simplified management Author Affiliations: Adelaide Institute for Sleep Health, Repatriation General Hospital (Drs Chai-Coetzer, Antic, Catcheside,Vowles,andMcEvoyandMsRowland),DepartmentofMedicine (DrsChai-Coetzer,Antic,Catcheside, and McEvoy and Ms Rowland), and Discipline of General Practice (Dr Reed), Finders University, Division ofHealthSciences,UniversityofSouthAustralia (DrEsterman), andSouthernAdelaide-Fleurieu-Kangaroo Island MedicareLocal (DrWilliams),Adelaide, SouthAustralia; and Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales (Dr Eckermann); and School of Health, Charles Darwin University,Darwin,NorthernTerritory(DrDunn),Australia. Corresponding Author: Ching Li Chai-Coetzer, MBBS, PhD, Adelaide Institute for Sleep Health, Repatriation General Hospital, Daws Road, Daw Park, South Australia, 5041 ([email protected] .au). Importance Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea. With appropriate training and simplified management tools, primary care physicians are ideally positioned to take on a greater role in diagnosis and treatment.