Development and outcomes of a primary care-based sleep assessment service in Canterbury, New Zealand

• Published in: NPJ primary care respiratory medicine 2017-04, Vol.27 (1), p.26-6, Article 26
• Main Authors: Epton, Michael J., Kelly, Paul T., Shand, Brett I., Powell, Sallyanne V., Jones, Judith N., McGeoch, Graham R. B., Hlavac, Michael C.
• Format: Article
• Language: English
• Subjects: 692/700/139; 692/700/228; Continuous Positive Airway Pressure; Delayed Diagnosis - prevention & control; Delivery of Health Care - organization & administration; Humans; Internal Medicine; Medicine; Medicine & Public Health; New Zealand; Oximetry - methods; Pneumology/Respiratory System; Polysomnography; Primary Care Medicine; Primary Health Care - organization & administration; Program Development; Referral and Consultation; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - therapy; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - therapy; Sleep disorders; Sleep Medicine Specialty; Sleep Wake Disorders - diagnosis; Sleep Wake Disorders - therapy; Thoracic Surgery
• ISSN: 2055-1010; 2055-1010
• DOI: 10.1038/s41533-017-0030-1

Prior to 2007, increasing demand for sleep services, plus inability to adequately triage severity, led to long delays in sleep assessment and accessing continuous positive airway pressure. We established a community sleep assessment service carried out by trained general practices using a standardised tool and overnight oximetry. All cases were discussed at a multi-disciplinary meeting, with four outcomes: severe obstructive sleep apnoea treated with continuous positive airway pressure; investigation with more complex studies; sleep physician appointment; no or non-severe sleep disorder for general practitioner management. Assessment numbers increased steadily (~400 in 2007 vs. 1400 in 2015). Median time from referral to assessment and multi-disciplinary meeting was 28 and 48 days, respectively. After the first multi-disciplinary meeting, 23% of cases were assessed as having severe obstructive sleep apnoea. More complex studies (mostly flow based) were required in 49% of patients, identifying severe obstructive sleep apnoea in a further 13%. Thirty-seven percent of patients had obstructive sleep apnoea severe enough to qualify for funded treatment. Forty-eight percent of patients received a definitive answer from the first multi-disciplinary meeting. Median time from referral to continuous positive airway pressure for ‘at risk’ patients with severe obstructive sleep apnoea, e.g., commercial drivers, was 49 days, while patients with severe obstructive sleep apnoea but not ‘at risk’ waited 261 days for continuous positive airway pressure. Ten percent of patients required polysomnography, and 4% saw a sleep specialist. In conclusion, establishment of a community sleep assessment service and sleep multi-disciplinary meeting led to significantly more assessments, with short waiting times for treatment, especially in high-risk patients with severe obstructive sleep apnoea. Most patients can be assessed without more complex studies or face-to-face review by a sleep specialist. Sleep disorders: More assessments, shorter waits with community sleep service A community-based service for common sleep disorders can provide rapid and easily accessed sleep assessment and treatment. A team led by Michael Hlavac and Michael Epton from Christchurch Hospital describe the creation of a sleep assessment service within the Canterbury district of New Zealand, in which initial assessments are conducted throughout the community by general practice teams under guidance and advice f