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Family GP's Could Take More Active Role With Sleep Apnoea
Here's an interesting article about how our GP's could treat uncomplicated Sleep Apnoea:-
Family Doc's Can Treat Simple Sleep Apnoea
With some basic training, primary care doctors and nurses could treat uncomplicated sleep apnoea cases, according to a new study.
With some basic training, primary care doctors and nurses could treat uncomplicated sleep apnoea, according to a new study from Australia that highlights the potential cost savings compared to treatment at specialty sleep medicine centers.
The researchers, who followed 155 people with sleep apnoea over six months, found that those treated by family doctors and nurses who had undergone a brief training regimen improved just as much on a scale that measures daytime tiredness as people who were treated by sleep specialists.
"We're suggesting that with the right training and motivation (sleep apnoea) can be taken care of at the primary care level with the help of specialists," said Dr Doug McEvoy, the study's lead author from the Adelaide Institute for Sleep Health at Repatriation General Hospital in Daw Park.
How the study was done
People with sleep apnea stop breathing for short periods when their airway collapses or gets blocked while they're asleep. The condition is most common among middle-aged, overweight adults and has been tied to a range of cardiovascular problems.
In the early 1990s, it was estimated that between 2 % and 4% of adults had sleep apnoea, but with rising obesity, the condition is likely more common, McEvoy and his colleagues write in the Journal of the American Medical Association.
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Costs involved in study
A CPAP unit costs between $1,000(R 9173.90) and $2,000(R 18347.80).Previous research has demonstrated that sleep specialists can safely use at-home sleep testing devices and outpatient care to manage sleep apnoea, and McEvoy's team speculated that primary care doctors could do the same with some training.
For the new study, the researchers recruited patients between 25 years old and 70 years old, who were seeing one of 34 doctors in Southern Australia between September 2008 and June 2010.The doctors, as well as community-based nurses, went through a training program developed by sleep medicine specialists and accredited by the Royal Australasian College of General Practitioners.
It included a six-hour course taken by all the doctors and nurses, plus, for the nurses, a five-day in-service training with specialist nurses at a sleep center.
The main interventions the primary care providers were able to offer after the training were home diagnostic testing, CPAP, a special jaw splint that helps keep the airway from collapsing or referral for upper airway surgery. At the beginning of the study, each patient completed a questionnaire about whether they were at risk for sleep apnoea.
They then wore a device at home while they slept that recorded how often they stopped breathing. Of the 155 patients found to have sleep apnoea, 81 were treated by their primary care physicians and nurses.
Patients who sent to sleep specialists
The other 74 patients were sent to sleep specialists. At the beginning of their treatment, the participating patients all scored, on average, around 13 on a scale that rates daytime tiredness from zero (not sleepy) to 24 (extreme sleepiness). A score of 8 on the scale represents mild tiredness, for example.
After six months of treatment, the average daytime tiredness score fell to about a 7 in both groups. Their scores on tests measuring other symptoms of sleep disorders and sleep apnoea also fell about the same amount in both groups. McEvoy told Reuters Health that taking care of patients in a primary care setting saved about 40% in costs, compared to patients who went to a sleep specialist.
In this study, it cost about $1,600(R 14678.24) for a primary care doctor to treat a patient with sleep apnoea, compared to $2,600(R23852.14) for a specialist to provide the care.
"I think this paper is important, because it shows primary care physicians are capable of identifying this population that probably can be taken care of by primary care doctors who have trained personnel," said Dr Seva Polotsky, who studies sleep apnea at Johns Hopkins University School of Medicine in Baltimore.
But Polotsky, who was not involved with the new study, pointed out that sleep apnea patients shouldn't expect to be treated by their family doctors right now, because most physicians don't have the needed training.
Source http://www.health24.com/Medical/Sleep/News/Family-docs-can-treat-si...
In another article on the National Institutes of Health's (NIH) website they describe how family doctor's can check for the likelihood of Sleep Apnoea:-
Medical and Family Histories
If you think you have a sleep problem, consider keeping a sleep diary for 1 to 2 weeks. Bring the diary with you to your next medical appointment.
Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel at various times during the day. This information can help your doctor figure out whether you have a sleep disorder.
You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's "Your Guide to Healthy Sleep."
At your appointment, your doctor will ask you questions about how you sleep and how you function during the day.
Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you're not aware of such symptoms and must ask a family member or bed partner to report them.
Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.
Many people aren't aware of their symptoms and aren't diagnosed.
If you're a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms.
Physical Exam
Your doctor will check your mouth, nose, and throat for extra or large tissues. Children who have sleep apnea might have enlarged tonsils. Doctors may need only a physical exam and medical history to diagnose sleep apnea in children.
Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.
(Full article can be found at http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/dia...
Views: 101
Replies to This Discussion
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Permalink Reply by symmit on
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I've thought for a while that most GPs could do an oximitry overnight test (equipment cost <100 quid!) and supply an autocpap, and practice nurses and local support groups could monitor compliance and stuff.
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I believe there are a number of trials going on around the UK at the moment, where GPs are having much greater involvement in diagnosing and treatment of OSA. Seems a sensible idea to me. I also think dentists could play a part in identifying people with OSA.
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Permalink Reply by Terry Vella on
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Kath, I would really love to rant and vent especially seeing the first study was done in Australia, I can only speak from mine and my sisters experience but they have no idea. I went to my GP for 2 years, weekly sometimes daily, telling him everytime I couldn't sleep and I couldn't breathe when I did sleep. He kept sending me to every Specialist except the right one and Specialist are just as bad. I even went to a Specialist of Specialists (no I am not stuttering ) that diagnoses anything and she was the same as the others and said I had deppression and take my meds and I would be Ok, well I wasn't. If any patient has any illness and has long term sleep issues, a sleep study should be mandatory, not meds. Sorry to be negative but from my point of view nothing will change because Drs and specialist want to treat symptoms no the cause because there is too much money in dolling out meds (yes, I am very cynical). Well I have had my vent and rant so, hope everyone has a good sleep, it's 9.45am here, so I have to wait another 12 hours before I get my next good sleep and can't wait.
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Permalink Reply by Kath Hope on
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Yes, there are some GP practices getting more involved Lisa, but not many yet. It's funny you should mention dentists as last weekend we were at a dinner party with a dentist and I told him what to look out for in future, so hope he'll pass this on to his colleagues.
Lisa said:I believe there are a number of trials going on around the UK at the moment, where GPs are having much greater involvement in diagnosing and treatment of OSA. Seems a sensible idea to me. I also think dentists could play a part in identifying people with OSA.
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I hear you loud and clear Terry, which is why it would be a good thing if GP's were educated and trained more in this, as they would then spot it easier. My experience was very different, as everytime I went to my GP for exhaustion he would ask me about my sleep, and each time I assured him my sleep was fine (which I thought it was). I was never aware of stopping breathing, slept like a log in my opinion, and my snoring never bothered me - even hubby had got used to it lol. I never thought to mention my sleep paralysis, but there again he wouldn't have known about the connection, as even people in 'our world' don't all know about this. My GP was as shocked as me when I got diagnosed, and like I've put in 'My Story' on the main website, he even pointed out that had we known, we could have saved the NHS a lot of money with all the tests I kept having and prescriptions I needed!
Incidentally Terry, I came across an article from your side of the pond, stating 1 in 4 Australians are at risk of OSA, so it shouldn't be long before your GP's are clued up http://www.medicalobserver.com.au/news/one-in-four-australians-at-r...
Terry Vella said:Kath, I would really love to rant and vent especially seeing the first study was done in Australia, I can only speak from mine and my sisters experience but they have no idea. I went to my GP for 2 years, weekly sometimes daily, telling him everytime I couldn't sleep and I couldn't breathe when I did sleep. He kept sending me to every Specialist except the right one and Specialist are just as bad. I even went to a Specialist of Specialists (no I am not stuttering ) that diagnoses anything and she was the same as the others and said I had deppression and take my meds and I would be Ok, well I wasn't. If any patient has any illness and has long term sleep issues, a sleep study should be mandatory, not meds. Sorry to be negative but from my point of view nothing will change because Drs and specialist want to treat symptoms no the cause because there is too much money in dolling out meds (yes, I am very cynical). Well I have had my vent and rant so, hope everyone has a good sleep, it's 9.45am here, so I have to wait another 12 hours before I get my next good sleep and can't wait.
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Kath, I think they already know but just prefer not to do anything about it because they make more money from not diagnosing it than they would if they did and we would all be healthy. It's funny I just ran into a friend I haven't seen for a few years and his brother in law and neighbour have sleep apnea and CPAPs and love them, that's not the funny thing, I ran my theory past him as I think he is a wise man, he has a theory that they probably have cures for other illnesses like cancer but don't want to let them out as if they cure them there won't be as many sick people and they won't have to spend money on meds etc. I'm coming around to his thinking or maybe we are just nuts lol.
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