scholarly journals O021 Preferred attributes of care pathways for obstructive sleep apnoea from the perspective of diagnosed patients and high-risk individuals: a discrete choice experiment

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A10-A10
Author(s):  
A Natsky ◽  
A Vakulin ◽  
C Chai Coetzer ◽  
R Adams ◽  
R McEvoy ◽  
...  
Keyword(s):  
High Risk ◽  
Discrete Choice ◽  
Obstructive Sleep Apnoea ◽  
Choice Experiment ◽  
Sleep Apnoea ◽  
Care Pathways ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Ongoing Care

Abstract Background The current health care system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high-risk of OSA. This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features. Methods A discrete choice experiment (DCE) was undertaken in two groups: those with a formal diagnosis of OSA (n=421) and those undiagnosed but at high-risk of having OSA (n=1033). The DCE approach used mixed logit regression models to determine preferences relating to eight salient features of OSA management pathway, i.e. initial assessment, setting and diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow up visits. Results The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results, and sleep specialists to recommend treatment and as ongoing care providers. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for sleep study testing and ongoing care provision. Discussion The DCE results offer a promising approach for systematic incorporation of patient and high-risk groups preferences into the future design and delivery of care pathways for OSA management.

scholarly journals Obstructive sleep apnoea is not a risk factor for incident hospitalised depression: a historical cohort study

2017 ◽  
Vol 49 (6) ◽  
pp. 1601361 ◽  
Author(s):  
Tetyana Kendzerska ◽  
Andrea S. Gershon ◽  
Gillian A. Hawker ◽  
George A. Tomlinson ◽  
Richard S. Leung
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Cox Regression ◽  
Sleep Apnoea ◽  
Sleep Study ◽  
Historical Cohort ◽  
Cox Regression Analysis ◽  
Younger Age ◽  
Obstructive Sleep ◽  
Potential Link

We evaluated whether obstructive sleep apnoea (OSA) was related to the incidence of hospitalisation for depression, a robust end-point that is unlikely to result from misdiagnosis.All adults referred with suspected OSA who underwent a diagnostic sleep study at a large urban academic hospital between 1994 and 2010 and were linked to provincial health administrative data between 1991 and 2015 were included. Cox regression analysis was used to investigate the association between OSA symptoms and severity and incident hospitalised depression, the primary outcome.Over a median follow-up of 9.7 years, 136 (1.3%) out of 10 149 participants were hospitalised for depression. A significant crude effect of OSA symptoms (waking unrefreshed and impact on memory and concentration) on hospitalised depression became nonsignificant after controlling for confounders. Apnoea–hypopnoea index was not significantly associated with the outcome: adjusted hazard ratio (33 versus6 events·h−1) 1.13 (95% CI 0.91–1.40). Factors associated with hospitalised depression were female sex, younger age, use of hypnotics, alcoholism and unemployment.In a large clinical cohort with suspected OSA, controlling for confounders, OSA symptoms and severity were not related to the risk of hospitalisation for depression, suggesting that previously reported links between OSA and depression may be due to overlapping diagnostic criteria. However, our findings cannot exclude a potential link between OSA and milder depression.

scholarly journals Home oximetry to screen for obstructive sleep apnoea in Down syndrome

2018 ◽  
Vol 103 (10) ◽  
pp. 962-967 ◽  
Author(s):  
Catherine M Hill ◽  
Heather E Elphick ◽  
Michael Farquhar ◽  
Paul Gringras ◽  
Ruth M Pickering ◽  
...  
Keyword(s):  
Down Syndrome ◽  
High Risk ◽  
Obstructive Sleep Apnoea ◽  
Training Sample ◽  
Sleep Apnoea ◽  
Validation Sample ◽  
Sleep Study ◽  
Children With Down Syndrome ◽  
Sleep Studies ◽  
Obstructive Sleep

ObjectiveChildren with Down syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is recommended. Diagnosis of OSA should be confirmed with multichannel sleep studies. We aimed to determine whether home pulse oximetry (HPO) discriminates children at high risk of OSA, who need further diagnostic multichannel sleep studies.DesignCross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data.PatientsChildren with Down syndrome aged 0.5–6 years.InterventionDiagnostic multichannel sleep study and HPO.Main outcome measuresSensitivity and specificity of HPO to predict moderate-to-severe OSA.Results161/202 children with Down syndrome met quality criteria for inclusion and 25 had OSA. In this training sample, the best HPO parameter predictors of OSA were the delta 12 s index >0.555 (sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO2) achieved sensitivity of 96% but reduced specificity to 52%. All predictors retained or improved sensitivity in a clinical validation sample of 50 children with variable loss of specificity, best overall was the delta 12 s index, a measure of baseline SpO2 variability (sensitivity 92%; specificity 63%).ConclusionsHPO screening could halve the number of children with Down syndrome needing multichannel sleep studies and reduce the burden on children, families and health services alike. This approach offers a practical universal screening approach for OSA in Down syndrome that is accessible to the non-specialist paediatrician.

Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy

2010 ◽  
Vol 125 (2) ◽  
pp. 193-198 ◽  
Author(s):  
S M Powell ◽  
M Tremlett ◽  
D A Bosman
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Life Assessment ◽  
Effect Sizes ◽  
Obstructive Sleep ◽  
Disordered Breathing

AbstractObjective:To assess the quality of life of UK children with sleep-disordered breathing undergoing adenotonsillectomy, by using the Obstructive Sleep Apnoea 18 questionnaire and determining score changes and effect sizes.Design:Prospective, longitudinal study.Setting:The otolaryngology department of a university teaching hospital in Northern England.Participants:Twenty-eight children for whom adenotonsillectomy was planned as treatment for sleep-disordered breathing, and who had either a clinical history consistent with obstructive sleep apnoea or a polysomnographic diagnosis.Main outcome measure:The Obstructive Sleep Apnoea 18 questionnaire, a previously validated, disease-specific quality of life assessment tool; changes in questionnaire scores and effect sizes were assessed.Methods:The Obstructive Sleep Apnoea 18 questionnaire was administered to each child's parent pre-operatively, then again at the follow-up appointment. Questionnaire scores ranged from 1 to 7. Score changes were analysed using the paired t-test; effect sizes were calculated using 95 per cent confidence intervals.Results:Complete data were obtained for 22 children (mean age, 61 months). Ten had undergone pre-operative polysomnography. Twenty-one children underwent adenotonsillectomy (one underwent tonsillectomy). Median follow up was eight weeks (interquartile range, six to 11 weeks). Following surgery, the overall mean score improvement was 2.6 (p < 0.0001) and the mean effect size 2.4 (95 per cent confidence interval 1.9 to 2.8). There were significant improvements in each of the individual questionnaire domains, i.e. sleep disturbance (mean score change 3.9, p < 0.0001), physical suffering (2.2, p < 0.0001), emotional distress (2.0, p = 0.0001), daytime problems (1.8, p = 0.0001) and caregiver concerns (2.6, p < 0.0001).Conclusion:In these children with sleep-disordered breathing treated by adenotonsillectomy, Obstructive Sleep Apnoea 18 questionnaire results indicated significantly improved mean score changes and effect sizes across all questionnaire domains, comparing pre- and post-operative data.

scholarly journals High Risk Characteristics for Recurrent Cardiovascular Events among Patients with Obstructive Sleep Apnoea in the SAVE Study

2018 ◽  
Vol 2-3 ◽  
pp. 59-65 ◽  
Author(s):  
Weiwei Quan ◽  
Danni Zheng ◽  
R. Douglas McEvoy ◽  
Ferran Barbe ◽  
Riu Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Obstructive Sleep Apnoea ◽  
Cardiovascular Events ◽  
Sleep Apnoea ◽  
Risk Characteristics ◽  
Obstructive Sleep

Effect of a 1-week intense myofunctional training on obstructive sleep apnoea in children with Down syndrome

2018 ◽  
Vol 104 (3) ◽  
pp. 275-279 ◽  
Author(s):  
Magnus von Lukowicz ◽  
Nina Herzog ◽  
Sebastian Ruthardt ◽  
Mirja Quante ◽  
Gabriele Iven ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Marginal Effect ◽  
Sleep Study ◽  
Desaturation Index ◽  
Intensive Training ◽  
Children With Down Syndrome ◽  
Training Camp ◽  
Obstructive Sleep

BackgroundObstructive sleep apnoea (OSA) is common in children with Down syndrome (DS), yet difficult to treat. As muscular hypotonia of the upper airway may cause OSA and is also common in DS, we tested whether intense myofunctional therapy improves OSA in children with DS.Patients and methodsForty-two children underwent cardiorespiratory sleep studies immediately before and after a 1-week intensive training camp consisting of three daily 45 min sessions of myofunctional exercises according to Padovan. Primary outcome was the mixed-obstructive-apnoea/hypopnoea index (MOAHI), secondary outcomes the ≤3% oxygen desaturation index (DI3), the ≤90% desaturation index (DI90) and the lowest pulse oximeter saturation (SpO2nadir).ResultsEighteen recordings had ≥3 hours of artefact-free recording in both the pretreatment and post-treatment sleep study and were therefore included in the analysis. Mean age was 6.3 years (SD 2.5); 83% had OSA prior to intervention. Mean MOAHI was 6.4 (SD 8.6) before and 6.4 (SD 10.8) after the intervention (p>0.05); the DI3 and SpO2nadir also did not change. Only the DI90 decreased significantly from 2.7 (SD 4.5) to 2.1 (SD 3.7) (p<0.05).ConclusionThe 1-week intense myofunctional training camp evaluated here in children with DS had only a marginal effect on OSA. Whether a longer follow-up period or duration of intervention would yield stronger effects remains to be determined.

scholarly journals Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

2019 ◽  
Vol 8 (12) ◽  
pp. 2121 ◽  
Author(s):  
Kate Sutherland ◽  
Peter A. Cistulli
Keyword(s):  
Health Outcomes ◽  
Obstructive Sleep Apnoea ◽  
Productivity Loss ◽  
Sleep Apnoea ◽  
World Health ◽  
Cardiometabolic Health ◽  
Accident Risk ◽  
Sleep Study ◽  
Pharyngeal Airway ◽  
Obstructive Sleep

Obstructive sleep apnoea (OSA) represents a significant global health burden, with impact on cardiometabolic health, chronic disease, productivity loss and accident risk. Oral appliances (OA) are an effective therapy for OSA and work by enlarging and stabilising the pharyngeal airway to prevent breathing obstructions during sleep. Although recommended in clinical guidelines for OSA therapy, they are often considered only as second-line therapy following positive airway pressure (PAP) therapy failure. There has been a long-standing barrier to selecting OA over PAP therapy due to the inability to be certain about the level of efficacy in individual OSA patients. A range of methods to select OSA patients for OA therapy, based on the outcome of a single sleep study night, have been proposed, although none has been widely validated for clinical use. Emergent health outcome data suggest that equivalent apnoea–hypopnea index reduction may not be necessary to produce the same health benefits of PAP. This may be related to the more favourable adherence to OA therapy, which can now be objectively verified. Data on longer term health outcomes are needed, and there are additional opportunities for device improvement and combination therapy approaches. OAs have an important role in precision care of OSA as a chronic disorder through a multi-disciplinary care team. Future studies on real-world health outcomes following OA therapy are needed.

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