Ken M. Kunisaki, MD, MS; Nancy Greer, PhD; Wajahat Khalil, MD; Erin Koffel, PhD; Eva Koeller, BA; Roderick MacDonald, MS; Timothy J. Wilt, MD, MPH
Disclaimer: The views expressed in this article are those of the authors and do not reflect the views of the U.S. government, the Department of Veterans Affairs, or any of the authors' affiliated academic institutions.
Financial Support: By the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The Office of Research and Development also provided protected research time in support of this study.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2511.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: The protocol for the full evidence report is registered in PROSPERO (CRD42016036810). Statistical code: Not applicable. Data set: See the supplement tables.
Requests for Single Reprints: Timothy J. Wilt, MD, MPH, Professor of Medicine, University of Minnesota School of Medicine, Minneapolis VA Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Kunisaki, Greer, Khalil, Koffel, and Wilt; Ms. Koeller; and Mr. MacDonald: Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417.
Author Contributions: Conception and design: K.M. Kunisaki, N. Greer, W. Khalil, E. Koffel, E. Koeller, T.J. Wilt.
Analysis and interpretation of the data: K.M. Kunisaki, N. Greer, W. Khalil, E. Koffel, E. Koeller, R. MacDonald, T.J. Wilt.
Drafting of the article: K.M. Kunisaki, N. Greer, E. Koffel, E. Koeller, R. MacDonald, T.J. Wilt.
Critical revision of the article for important intellectual content: K.M. Kunisaki, N. Greer, W. Khalil, E. Koffel, T.J. Wilt.
Final approval of the article: K.M. Kunisaki, N. Greer, W. Khalil, E. Koffel, E. Koeller, R. MacDonald, T.J. Wilt.
Statistical expertise: R. MacDonald, T.J. Wilt.
Obtaining of funding: T.J. Wilt.
Administrative, technical, or logistic support: N. Greer, T.J. Wilt.
Collection and assembly of data: K.M. Kunisaki, N. Greer, E. Koffel, E. Koeller, R. MacDonald, T.J. Wilt.
Obstructive sleep apnea (OSA) diagnosis and care models rely on sleep specialist physicians (SSPs) and can be expensive and inefficient.
To assess OSA case-finding accuracy and comparative effectiveness of care by non–sleep specialists (NSSs) and SSPs.
MEDLINE and CINAHL from January 2000 through July 2017.
English-language trials or observational studies comparing case finding or care by SSPs versus providers not specifically trained as SSPs (NSSs) for adults with suspected or diagnosed OSA.
One investigator extracted data and assessed risk of bias and strength of evidence, with confirmation by a second investigator. Primary outcomes were patient-centered (mortality, access to care, quality of life, patient satisfaction, adherence, symptom scores, and adverse events). Intermediate outcomes included resource use, costs, time to initiation of treatment, and case finding.
Four observational studies (n = 580; mean age, 52 years; 77% male) reported good agreement between NSSs and SSPs on appropriate diagnostic testing and classification of OSA severity (low-strength evidence). Five randomized trials and 3 observational studies (n = 1515; mean age, 52 years; 68% male) found that care provided by NSSs and SSPs resulted in similar quality of life, adherence, and symptom scores (low-strength evidence). Evidence was insufficient for access to care and adverse events.
Many outcomes were reported infrequently or not at all. Many NSSs had extensive training or experience in sleep medicine, which limits generalizability of findings to providers with less experience.
Care by NSSs and SSPs resulted in similar outcomes in adults with known or suspected OSA. Studies are needed to determine care model implementation and reproducibility of results in nonacademic settings and among less experienced NSSs.
Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO: CRD42016036810 [full Veterans Affairs Evidence-based Synthesis Program report])
Kunisaki KM, Greer N, Khalil W, Koffel E, Koeller E, MacDonald R, et al. Provider Types and Outcomes in Obstructive Sleep Apnea Case Finding and Treatment: A Systematic Review. Ann Intern Med. 2018;168:195–202. doi: 10.7326/M17-2511
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Published: Ann Intern Med. 2018;168(3):195-202.
Published at www.annals.org on 30 January 2018
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