GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units

BACKGROUND Obstructive sleep apnea syndrome (OSA) is a chronic sleep disorder characterized by repeated episodes of upper airway collapse during sleep. This leads to arterial hypoxemia and sleep disruption and causes daytime sleepiness and several associated dysfunctions, including cardiovascular, r...

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Autores: Tarraubella Balanya, Núria, Batlle Garcia, Jordi de, Nadal Braque, Núria, Castro-Grattoni, Anabel L., Gómez Falguera, Silvia, Sánchez de la Torre, Manuel, Barbé Illa, Ferran
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Recursos:Universitat de Lleida (UdL)
Repositorio:Repositori Obert UdL
OAI Identifier:oai:repositori.udl.cat:10459.1/59846
Acesso em linha:https://doi.org/10.1038/s41533-016-0010-x
http://hdl.handle.net/10459.1/59846
Access Level:acceso abierto
Palavra-chave:Síndromes d'apnea del son
Atenció primària
Trastorns del son
Sleep apnea syndromes
Primary health care
Sleep disorders
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repository_id_str
dc.title.none.fl_str_mv GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
title GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
spellingShingle GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
Tarraubella Balanya, Núria
Síndromes d'apnea del son
Atenció primària
Trastorns del son
Sleep apnea syndromes
Primary health care
Sleep disorders
title_short GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
title_full GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
title_fullStr GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
title_full_unstemmed GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
title_sort GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep units
dc.creator.none.fl_str_mv Tarraubella Balanya, Núria
Batlle Garcia, Jordi de
Nadal Braque, Núria
Castro-Grattoni, Anabel L.
Gómez Falguera, Silvia
Sánchez de la Torre, Manuel
Barbé Illa, Ferran
author Tarraubella Balanya, Núria
author_facet Tarraubella Balanya, Núria
Batlle Garcia, Jordi de
Nadal Braque, Núria
Castro-Grattoni, Anabel L.
Gómez Falguera, Silvia
Sánchez de la Torre, Manuel
Barbé Illa, Ferran
author_role author
author2 Batlle Garcia, Jordi de
Nadal Braque, Núria
Castro-Grattoni, Anabel L.
Gómez Falguera, Silvia
Sánchez de la Torre, Manuel
Barbé Illa, Ferran
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Síndromes d'apnea del son
Atenció primària
Trastorns del son
Sleep apnea syndromes
Primary health care
Sleep disorders
topic Síndromes d'apnea del son
Atenció primària
Trastorns del son
Sleep apnea syndromes
Primary health care
Sleep disorders
description BACKGROUND Obstructive sleep apnea syndrome (OSA) is a chronic sleep disorder characterized by repeated episodes of upper airway collapse during sleep. This leads to arterial hypoxemia and sleep disruption and causes daytime sleepiness and several associated dysfunctions, including cardiovascular, respiratory, metabolic, inflammatory, cognitive, and behavioral disorders.(1) OSA is a relevant public health issue, with epidemiological studies showing a prevalence of 10% in middle-aged men and 3% in middle-aged women.(2) Moreover, OSA has been associated with the development of cardiovascular events(3,4) and resistant hypertension,(5) has a negative impact on quality of life,(6) and has even been shown to have a causative role in traffic accidents.(7) The application of continuous positive airway pressure (CPAP) is a highly effective treatment for OSA that can improve symptoms and quality of life, decrease traffic accidents and potentially lessen cardiovascular morbidity.(8,9) Furthermore, CPAP is cost-effective.(10) However, only approximately 10% of individuals with OSA are diagnosed and treated. This scarcity in diagnosis has direct public health consequences due to the above-mentioned health implications and the high economic costs associated with untreated OSA. Currently, the diagnosis and management of OSA are performed in highly specialized hospital-based sleep units (SUs), where full sleep studies (polysomnography (PSG)) or respiratory poligraphy (RP) can be conducted. However, this management approach has proven to be insufficient in identifying most OSA cases in the population, in addition to being cost-ineffective and generating long waiting lists.(11) Given that OSA is a common chronic disorder, we believe that all levels of a healthcare system, especially primary care (PC), should be included in its management.(12-14) The first trials assessing the management of OSA at the PC level reported satisfactory results.(15-19) Moreover, our group showed that CPAP compliance did not differ between the PC and SU setting and was more cost-effective in the PC setting. 19 However, in the above studies, although OSA management occurred at the PC level, diagnosis had always occurred in a SU. Therefore, in the current study, we aimed to determine the efficacy and cost-effectiveness of implementing a program for the diagnosis and management of OSA that can be conducted by PC personnel, and we compared these outcomes to those generated using the standard diagnosis and management protocols that are practiced in SUs. AIMS The main objectives of the GESAP study are to assess the efficacies of PC and SU programs for OSA management. These assessments will be made using the Epworth sleepiness scale (ESS) before and for 6 months after initiating the program to assess its cost-effectiveness based on both ESS and quality of life (EuroQol-5D). Secondary objectives include assessments of patient satisfaction, treatment compliance, and the number, severity, and evolution of the treatment's side effects.
publishDate 2016
dc.date.none.fl_str_mv 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://doi.org/10.1038/s41533-016-0010-x
http://hdl.handle.net/10459.1/59846
url https://doi.org/10.1038/s41533-016-0010-x
http://hdl.handle.net/10459.1/59846
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1038/s41533-016-0010-x
Npj Primary Care Respiratory Medicine, 2016, vol. 27, num. 1, p. 1-3
dc.rights.none.fl_str_mv cc-by (c) Tarraubella Balanya, Núria et al., 2016
info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by/3.0/es
rights_invalid_str_mv cc-by (c) Tarraubella Balanya, Núria et al., 2016
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Nature Publishing Group
publisher.none.fl_str_mv Nature Publishing Group
dc.source.none.fl_str_mv reponame:Repositori Obert UdL
instname:Universitat de Lleida (UdL)
instname_str Universitat de Lleida (UdL)
reponame_str Repositori Obert UdL
collection Repositori Obert UdL
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling GESAP trial rationale and methodology: management of patients with suspected obstructive sleep apnea in primary care units compared to sleep unitsTarraubella Balanya, NúriaBatlle Garcia, Jordi deNadal Braque, NúriaCastro-Grattoni, Anabel L.Gómez Falguera, SilviaSánchez de la Torre, ManuelBarbé Illa, FerranSíndromes d'apnea del sonAtenció primàriaTrastorns del sonSleep apnea syndromesPrimary health careSleep disordersBACKGROUND Obstructive sleep apnea syndrome (OSA) is a chronic sleep disorder characterized by repeated episodes of upper airway collapse during sleep. This leads to arterial hypoxemia and sleep disruption and causes daytime sleepiness and several associated dysfunctions, including cardiovascular, respiratory, metabolic, inflammatory, cognitive, and behavioral disorders.(1) OSA is a relevant public health issue, with epidemiological studies showing a prevalence of 10% in middle-aged men and 3% in middle-aged women.(2) Moreover, OSA has been associated with the development of cardiovascular events(3,4) and resistant hypertension,(5) has a negative impact on quality of life,(6) and has even been shown to have a causative role in traffic accidents.(7) The application of continuous positive airway pressure (CPAP) is a highly effective treatment for OSA that can improve symptoms and quality of life, decrease traffic accidents and potentially lessen cardiovascular morbidity.(8,9) Furthermore, CPAP is cost-effective.(10) However, only approximately 10% of individuals with OSA are diagnosed and treated. This scarcity in diagnosis has direct public health consequences due to the above-mentioned health implications and the high economic costs associated with untreated OSA. Currently, the diagnosis and management of OSA are performed in highly specialized hospital-based sleep units (SUs), where full sleep studies (polysomnography (PSG)) or respiratory poligraphy (RP) can be conducted. However, this management approach has proven to be insufficient in identifying most OSA cases in the population, in addition to being cost-ineffective and generating long waiting lists.(11) Given that OSA is a common chronic disorder, we believe that all levels of a healthcare system, especially primary care (PC), should be included in its management.(12-14) The first trials assessing the management of OSA at the PC level reported satisfactory results.(15-19) Moreover, our group showed that CPAP compliance did not differ between the PC and SU setting and was more cost-effective in the PC setting. 19 However, in the above studies, although OSA management occurred at the PC level, diagnosis had always occurred in a SU. Therefore, in the current study, we aimed to determine the efficacy and cost-effectiveness of implementing a program for the diagnosis and management of OSA that can be conducted by PC personnel, and we compared these outcomes to those generated using the standard diagnosis and management protocols that are practiced in SUs. AIMS The main objectives of the GESAP study are to assess the efficacies of PC and SU programs for OSA management. These assessments will be made using the Epworth sleepiness scale (ESS) before and for 6 months after initiating the program to assess its cost-effectiveness based on both ESS and quality of life (EuroQol-5D). Secondary objectives include assessments of patient satisfaction, treatment compliance, and the number, severity, and evolution of the treatment's side effects.Fondo de Investigación Sanitaria (PI 13/02004), Fondo Europeo de Desarrollo Regional (FEDER), Una manera de hacer Europa; the Spanish Respiratory Society (SEPAR); and Esteve-Teijin (Spain). Cofunded by Ministerio de Economía y Competitividad [COFUND2014-51501]. The authors would like to thank all PC personnel involved in the study, as well as the kind support from Maricel Arbonés, Olga Mínguez and Lídia Pascual (Group of Translational Research in Respiratory Medicine, IRB Lleida, Spain).Nature Publishing Group2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.1038/s41533-016-0010-xhttp://hdl.handle.net/10459.1/59846reponame:Repositori Obert UdL instname:Universitat de Lleida (UdL)InglésReproducció del document publicat a: https://doi.org/10.1038/s41533-016-0010-xNpj Primary Care Respiratory Medicine, 2016, vol. 27, num. 1, p. 1-3cc-by (c) Tarraubella Balanya, Núria et al., 2016info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by/3.0/esoai:repositori.udl.cat:10459.1/598462026-06-24T12:42:17Z
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