Effect of a targeted obstructive sleep apnea consult to improve access and quality at a sleep disorders center

Study Objectives: We sought to evaluate whether a targeted obstructive sleep apnea (OSA) consult (TOSAC) protocol that reduced sleep-specialist time spent with patients suspected of having OSA would improve quality of care compared with the previous clinical method for evaluation of patients internally referred for suspected OSA. Methods: Prospective cohort design. TOSAC patients received oximetry and criteria screening prior to a split-night polysomnography and a 45-minute sleep-specialist consult, while control patients received consult, testing, and a follow-up visit (90 minutes of sleep-specialist time). Results: We enrolled 186 TOSAC and 94 control patients. TOSAC patients completed their evaluation in a median of 7.0 days compared with 60.0 days for the controls (p < .001). At baseline, the TOSAC group was sleepier (Epworth Sleepiness Scale 13.9±4.5 vs 11.0±4.3; p < .001) and had a slightly lower quality of life (Functional Outcomes of Sleep Questionnaire 15.0±3.0 vs 16.8±2.2, p < .001) than controls. The apnea-hypopnea index noted at polysomnography was similar in TOSAC and control patients (28.6±29.5 vs 23.1±23.9, p = .156), and the prevalence of OSA was similar in both groups (75% vs 72%, p = .616). At 1 month of therapy, improvement in the Epworth Sleepiness Scale and overall patient satisfaction were similar between groups (all p > .10), while TOSAC patients had a slightly greater improvement on the Functional Outcomes of Sleep Questionnaire (p = .010). TOSAC patients reported better subjective continuous positive airway pressure compliance (median 42.0 vs 32.5 hours/week; p = .037). Conclusions: A protocol-driven evaluation pathway for OSA that used screening with oximetry and less sleep-specialist time shortened access and produced similar diagnoses, improvements in sleepiness and quality of life, and overall satisfaction.