Medicinsk teknologivurdering af obstruktiv ... - Danske Regioner

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Medicinsk teknologivurdering af obstruktiv ... - Danske Regioner

Medicinsk teknologivurdering af obstruktiv søvnapnø

Main conclusions

The authors of the report conclude:

Technology

Obstructive sleep apnoea (OSA)

Cardiorespiratory monitoring (CRM) performs satisfactory diagnostics when compared

with the diagnostic gold standard polysomnography (PSG) (moderate evidence). It

seems though that some mild cases of OSA would not be detected due to the lower sensibility

of CRM compared with PSG.

'Continuous positive airway pressure' (CPAP) has a positive effect on daytime sleepiness,

quality of life and the apnoea-hypopnoea index (AHI) (moderate to high evidence)

and results in a lower risk of traffic accidents (limited evidence). In relation to the effect

of CPAP on blood pressure results were inconsistent. There was no effect with regard

to cardiovascular disease (moderate evidence). Oral appliances can be used to treat patients

with light to moderate OSA and patient who cannot accept or tolerate CPAP

(moderate evidence). It is recommended to adopt a wait-and-see strategy for surgical

treatment until other treatments, especially CPAP, have been pursued. Based on the

structural conditions of the upper airways, indication for surgical intervention as the

primary treatment can be found in a few patients.

There is limited evidence that follow-up treatment either by telemedicine, intensive

support in the patient's home or cognitive behavioural therapy increase patient compliance.

Obesity hypoventilation syndrome (OHS)

Among patients with OHS, bilevel therapy and CPAP are better than no respiratory support

therapy evaluated on the basis of selected physiological conditions (limited evidence).

Registry data

The number of newly diagnosed patients corresponds to the patient base in each region.

Three in four newly diagnosed are men and the age group from 50 to 59 years is

most frequently represented.

The patients are primarily diagnosed using CRM; the most frequent treatment is CPAP.

The registry data showed a pronounced underreporting (data incompleteness) concerning

procedure codes. Data completeness has been increased since 2010.

Organisation

Sleep apnoea concerns more medical specialities. In Denmark, there are no national or

regional guidelines on which speciality would be best suited to cover diagnostics and

treatment of OSA. This is obvious, as sleep apnoea is part of the specialist training in

neurology and pulmonary medicine whereas a large number of the general practitioners

refer patients to ear, nose and throat departments.

A smaller questionnaire study among general practitioners showed among other things

that 75% of the general practitioners themselves reported limited knowledge of sleep

apnoea.

Side 13

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