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Distance to Specialist Medical Care and Diagnosis of Obstructive Sleep Apnea in Rural Saskatchewan.

ABSTRACT: Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. Patients with OSA symptoms are often not diagnosed clinically, which is a concern, given the health and safety risks associated with unmanaged OSA. The availability of fewer practicing medical specialists combined with longer travel distances to access health care services results in barriers to diagnosis and treatment in rural communities. This study aimed to (1) determine whether the proportion of adults reporting OSA symptoms in the absence of a sleep apnea diagnosis in rural populations varied by travel distance to specialist medical care and (2) assess whether any distance-related patterns were attributable to differences in the frequency of diagnosis among adults who likely required this specialist medical care. We used a cross-sectional epidemiologic study design, augmented by analysis of follow-up survey data. Our study base included adults who completed a 2010 baseline questionnaire for the Saskatchewan Rural Health Study. Follow-up occurred until 2015. 6525 adults from 3731 households constituted our sample. Statistical models used log-binomial regression. Rural adults who reported the largest travel distances (?250?km) to specialist medical care were 1.17 (95% CI: 1.07, 1.29) times more likely to report OSA symptoms in the absence of a sleep apnea diagnosis than those who reported the smallest (<100?km; referent) distances. However, the proportion of sleep apnea diagnoses was low and unaffected by reported travel distance among adults who likely required this specialist medical care. Our findings suggest factors other than travel distance may be contributing to the low sleep apnea diagnostic rate. This remains important as undiagnosed and untreated OSA has serious implications on the health of people and populations, but effective treatments are available. Health care access barriers to the diagnosis and treatment of OSA require evaluation to inform health care planning and delivery.

SUBMITTER: Spagnuolo CM

PROVIDER: S-EPMC6348862 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Distance to Specialist Medical Care and Diagnosis of Obstructive Sleep Apnea in Rural Saskatchewan.

Spagnuolo Catherine M CM McIsaac Michael M Dosman James J Karunanayake Chandima C Pahwa Punam P Pickett William W

Canadian respiratory journal 20190114

Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. Patients with OSA symptoms are often not diagnosed clinically, which is a concern, given the health and safety risks associated with unmanaged OSA. The availability of fewer practicing medical specialists combined with longer travel distances to access health care services results in barriers to diagnosis and treatment in rural communities. This study aimed to (1) determine whether the proportion of adults rep ...[more]

PMID: 30733845

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Project description:Study objectivesWe investigated the diagnostic accuracy for the identification of obstructive sleep apnea (OSA) and its severity of a noninvasive technology based on image processing (SleepWise).MethodsThis is an observational, prospective study to evaluate the degree of agreement between polysomnography (PSG) and SleepWise. We recruited 56 consecutive subjects with suspected OSA who were referred as outpatients to the Sleep Unit of the Hospital Universitari Germans Trias i Pujol (HUGTiP) from January 2013 to January 2014. All patients underwent laboratory PSG and image processing with SleepWise simultaneously the same night. Both PSG and SleepWise analyses were carried independently and blindly.ResultsWe analyzed 50 of the 56 patients recruited. OSA was diagnosed through PSG in a total of 44 patients (88%) with a median apnea-hypopnea index (AHI) of 25.35 (24.9). According to SleepWise, 45 patients (90%) met the criteria for a diagnosis of OSA, with a median AHI of 22.8 (22.03). An analysis of the ability of PSG and SleepWise to classify patients by severity on the basis of their AHI shows that the two diagnostic systems distribute the different groups similarly. According to PSG, 23 patients (46%) had a diagnosis of severe OSA, 11 patients (22%) moderate OSA, and 10 patients (20%) mild OSA. According to SleepWise, 20, 13, and 12 patients (40%, 26%, and 24%, respectively) had a diagnosis of severe, moderate, and mild OSA respectively. For OSA diagnosis, SleepWise was found to have sensitivity of 100% and specificity of 83% in relation to PSG. The positive predictive value was 97% and the negative predictive value was 100%. The Bland-Altman plot comparing the mean AHI values obtained through PSG and SleepWise shows very good agreement between the two diagnostic techniques, with a bias of -3.85, a standard error of 12.18, and a confidence interval of -0.39 to -7.31.ConclusionsSleepWise was reasonably accurate for noninvasive and automatic diagnosis of OSA in outpatients. SleepWise determined the severity of OSA with high reliability. The current study including simultaneous laboratory PSG and SleepWise processing image is proposed as a reasonable validation standard.

Project description:STUDY OBJECTIVES:Patients with obstructive sleep apnea (OSA) have been shown to have high levels of inflammatory markers. Anti-inflammatory treatment with montelukast and intranasal steroids have demonstrated efficacy for mild OSA in children; this has not been fully evaluated in adults. This study investigated the response of mild OSA in adults to anti-inflammatory medical therapy. METHODS:Adults aged ? 21 years with an apnea-hypopnea index (AHI) ? 15 events/h on polysomnography (PSG) were recruited to a prospective double-blind, randomized control trial. Patients were treated for 12 weeks with montelukast and fluticasone or placebo. All underwent a pretreatment and posttreatment PSG. Epworth Sleepiness Scale (ESS) score was obtained pretreatment and at 6 and 12 weeks posttreatment. RESULTS:A total of 26 patients completed the study with 13 in each group. Mean age in the treatment and placebo groups were 58.3 ± 10.3 and 54.8 ± 14 years, respectively. There was no significant difference between groups reporting nasal congestion (P = .186), rhinitis (P = .666), or snoring (P = .177). There was no difference in the pretreatment ESS score (P = .077), body mass index (P = .173), or AHI (P = .535). The posttreatment PSG in the treatment group demonstrated a significant increase in total sleep time (P = .02) and percent of stage R sleep (P = .05). Neither group showed significant change in AHI. In patients in the treatment group, the 6- and 12-week follow-up ESS scores were not significantly different from pretreatment scores (P = .37-.46). CONCLUSIONS:Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly increased. Self-reported improvement could be explained by observed changes in sleep parameters. Larger prospective studies could help elucidate the effects of medical therapy on adult patients with OSA. CLINICAL TRIAL REGISTRATION:Registry: ClinicalTrials.gov; Title: Montelukast and Nasa ICS for Treatment of Mild Obstructive Sleep Apnea in Adults; Identifier: NCT01089647; URL: https://clinicaltrials.gov/ct2/show/record/NCT01089647.

Project description:BackgroundRural communities represent a vulnerable population that would significantly benefit from hospital-based OSA screening given these areas tend to have significant health-care disparities and poor health outcomes. Although inpatient screening has been studied at urban hospitals, no study to date has assessed this approach in rural populations.MethodsThis study utilized the Electronic Medical Record (EMR) to generate a list of potential candidates by employing inclusion/exclusion criteria as screening. Subjects identified were then approached and offered information regarding the study. Screening for OSA entailed a tiered approach utilizing the sleep apnea clinical score (SAC) and portable sleep testing. Individuals identified as high risk (SAC ≥ 15) for OSA underwent evaluation with a portable sleep testing system while hospitalized. All participants with an apnea-hypopnea index (AHI) ≥5 events/h confirmed by a sleep medicine physician were considered screen positive for OSA. If approved/available, subjects screening positive for OSA were provided with an auto-titrating continuous positive airway pressure (PAP). Patient characteristics were analyzed using descriptive statistics. Categorical data were described using contingency tables, including counts and percentages. Continuously scaled measures were summarized by median with range. This study was registered with ClinicalTrials.gov. Identifier: NCT03056443.ResultsNine hundred and fifty-eight potential subjects were identified. The three most common reasons for exclusion included previous OSA diagnosis or exposure to PAP therapy (n = 357), advanced illness (n = 380), and declined participation by the individual (n = 68). The remaining 31 subjects underwent further evaluation for obstructive sleep apnea. Twenty-three subjects had a high sleep apnea clinic score. Per our study protocol, 13 subjects who screened positive for OSA were initiated on APAP therapy. Conclusion: Our study provides important insight into the burden of sleep-disordered breathing (SDB) and unique challenges of hospital-based OSA screening/treatment in a rural setting. Our study identified barriers to successful screening in a rural population that may be well addressed by adapting previous research in hospital sleep medicine.

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Distance to Specialist Medical Care and Diagnosis of Obstructive Sleep Apnea in Rural Saskatchewan.

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Distance to Specialist Medical Care and Diagnosis of Obstructive Sleep Apnea in Rural Saskatchewan.

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