Patricia Peñacoba1,2, M Antònia Llauger2,3, Ana M Fortuna1,2, Xavier Flor2,4, Gabriel Sampol2,5,6, Anna Maria Pedro Pijoan7, Núria Grau6,8, Carme Santiveri9, Joan Juvanteny2,10, José Ignacio Aoiz11, Joan Bayó11, Patricia Lloberes5,6, Mercè Mayos1,2,6. 1. Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 2. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Equip d'Atenció Primària Encants, Centre d'Atenció Primària (CAP) Maragall, Institut Català de la Salut, Barcelona, Spain. 4. CAP Chafarinas, Institut Català de la Salut, Barcelona, Spain. 5. Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 6. Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain. 7. Àrea Bàsica de Salut Gaudí, Consorci Sanitari Integral, Barcelona, Spain. 8. Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain. 9. Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain. 10. CAP Trinitat Vella, Institut Català de la Salut, Barcelona, Spain. 11. CAP El Clot, Institut Català de la Salut, Barcelona, Spain.
Abstract
STUDY OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.
STUDY OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.
Authors: Patricia Lloberes; Joaquín Durán-Cantolla; Miguel Ángel Martínez-García; José María Marín; Antoni Ferrer; Jaime Corral; Juan Fernando Masa; Olga Parra; Mari Luz Alonso-Álvarez; Joaquín Terán-Santos Journal: Arch Bronconeumol Date: 2011-03 Impact factor: 4.872
Authors: Safi U Khan; Crystal A Duran; Hammad Rahman; Manidhar Lekkala; Muhammad A Saleem; Edo Kaluski Journal: Eur Heart J Date: 2018-06-21 Impact factor: 29.983
Authors: M Sánchez-de-la-Torre; N Nadal; A Cortijo; J F Masa; J Duran-Cantolla; J Valls; S Serra; A Sánchez-de-la-Torre; M Gracia; F Ferrer; I Lorente; M C Urgeles; T Alonso; A Fuentes; F Armengol; M Lumbierres; F J Vázquez-Polo; F Barbé Journal: Thorax Date: 2015-04 Impact factor: 9.139
Authors: Francisco Campos-Rodriguez; Miguel A Martinez-Garcia; Montserrat Martinez; Joaquin Duran-Cantolla; Monica de la Peña; María J Masdeu; Monica Gonzalez; Felix del Campo; Inmaculada Gallego; Jose M Marin; Ferran Barbe; Jose M Montserrat; Ramon Farre Journal: Am J Respir Crit Care Med Date: 2012-11-15 Impact factor: 21.405
Authors: Juan Fernando Masa Jiménez; Ferran Barbé Illa; Francisco Capote Gil; Eusebio Chiner Vives; Josefa Díaz de Atauri; Joaquín Durán Cantolla; Salvador López Ortiz; José María Marín Trigo; José María Montserrat Canal; Manuela Rubio González; Joaquín Terán Santos; Carlos Zamarrón Sanz Journal: Arch Bronconeumol Date: 2007-04 Impact factor: 4.872
Authors: Giuseppe Mancia; Robert Fagard; Krzysztof Narkiewicz; Josep Redon; Alberto Zanchetti; Michael Böhm; Thierry Christiaens; Renata Cifkova; Guy De Backer; Anna Dominiczak; Maurizio Galderisi; Diederick E Grobbee; Tiny Jaarsma; Paulus Kirchhof; Sverre E Kjeldsen; Stéphane Laurent; Athanasios J Manolis; Peter M Nilsson; Luis Miguel Ruilope; Roland E Schmieder; Per Anton Sirnes; Peter Sleight; Margus Viigimaa; Bernard Waeber; Faiez Zannad; Josep Redon; Anna Dominiczak; Krzysztof Narkiewicz; Peter M Nilsson; Michel Burnier; Margus Viigimaa; Ettore Ambrosioni; Mark Caufield; Antonio Coca; Michael Hecht Olsen; Roland E Schmieder; Costas Tsioufis; Philippe van de Borne; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Cetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Denis L Clement; Antonio Coca; Thierry C Gillebert; Michal Tendera; Enrico Agabiti Rosei; Ettore Ambrosioni; Stefan D Anker; Johann Bauersachs; Jana Brguljan Hitij; Mark Caulfield; Marc De Buyzere; Sabina De Geest; Geneviève Anne Derumeaux; Serap Erdine; Csaba Farsang; Christian Funck-Brentano; Vjekoslav Gerc; Giuseppe Germano; Stephan Gielen; Herman Haller; Arno W Hoes; Jens Jordan; Thomas Kahan; Michel Komajda; Dragan Lovic; Heiko Mahrholdt; Michael Hecht Olsen; Jan Ostergren; Gianfranco Parati; Joep Perk; Jorge Polonia; Bogdan A Popescu; Zeljko Reiner; Lars Rydén; Yuriy Sirenko; Alice Stanton; Harry Struijker-Boudier; Costas Tsioufis; Philippe van de Borne; Charalambos Vlachopoulos; Massimo Volpe; David A Wood Journal: Eur Heart J Date: 2013-06-14 Impact factor: 29.983
Authors: Patricia Peñacoba; Maria Antònia Llauger; Ana María Fortuna; Xavier Flor; Gabriel Sampol; Anna Maria Pedro-Pijoan; Núria Grau; Carme Santiveri; Joan Juvanteny; José Ignacio Aoiz; Joan Bayó; Patricia Lloberes; Mercè Mayos Journal: BMC Pulm Med Date: 2022-01-15 Impact factor: 3.317