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Original article
Role of primary care in the follow-up of patients with obstructive sleep apnoea undergoing CPAP treatment: a randomised controlled trial
  1. M Sánchez-de-la-Torre1,2,
  2. N Nadal1,3,
  3. A Cortijo1,
  4. JF Masa2,4,
  5. J Duran-Cantolla2,5,
  6. J Valls6,
  7. S Serra1,
  8. A Sánchez-de-la-Torre1,2,
  9. M Gracia3,
  10. F Ferrer3,
  11. I Lorente3,
  12. M C Urgeles3,
  13. T Alonso3,
  14. A Fuentes3,
  15. F Armengol3,
  16. M Lumbierres1,
  17. F J Vázquez-Polo7,
  18. F Barbé1,2,
  19. for the Respiratory Medicine Research Group
  1. 1Respiratory Department, Arnau de Vilanova-Santa María University Hospital, IRB Lleida, Lleida, Catalonia, Spain
  2. 2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
  3. 3Primary Care Unit of Lleida, Catalonia, Spain
  4. 4Respiratory Department, San Pedro de Alcantara Hospital, Cáceres, Spain
  5. 5Araba University Hospital, UPV, BioAraba Institute, Vitoria, Spain
  6. 6Department of Statistics, IRB Lleida, Catalonia, Spain
  7. 7Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain
  1. Correspondence to Dr Ferran Barbé, Respiratory Department, Hospital Univ Arnau de Vilanova, Rovira Roure, 80, Lleida 25198, Spain; febarbe.lleida.ics{at}gencat.cat

Abstract

Objective To evaluate whether follow-up of patients with obstructive sleep apnoea (OSA) undergoing CPAP treatment could be performed in primary care (PC) settings.

Design Non-inferiority, randomised, prospective controlled study.

Settings Sleep unit (SU) at the University Hospital and in 8 PC units in Lleida, Spain.

Participants Patients with OSA were randomised to be followed up at the SU or PC units over a 6-month period.

Main outcomes measured The primary outcome was CPAP compliance at 6 months. The secondary outcomes were Epworth Sleep Scale (ESS) score, EuroQoL, patient satisfaction, body mass index (BMI), blood pressure and cost-effectiveness.

Results We included 101 patients in PC ((mean±SD) apnoea–hypopnoea index (AHI) 50.8±22.9/h, age 56.2±11 years, 74% male) and 109 in the SU (AHI 51.4±24.4/h, age 55.8±11 years, 77% male)). The CPAP compliance was (mean (95% CI) 4.94 (4.47 to 5.5) vs 5.23 (4.79 to 5.66) h, p=0.18) in PC and SU groups, respectively. In the SU group, there were greater improvements in ESS scores (mean change 1.79, 95% CI +0.05 to +3.53, p=0.04) and patient satisfaction (−1.49, 95% CI −2.22 to −0.76); there was a significant mean difference in BMI between the groups (0.57, 95% CI +0.01 to +1.13, p=0.04). In the PC setting, there was a cost saving of 60%, with similar effectiveness, as well as a decrease in systolic blood pressure (−5.32; 95% CI −10.91 to +0.28, p=0.06).

Conclusions For patients with OSA, treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative.

Trial registration number Clinical Trials NCT01918449.

  • Sleep apnoea

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