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Volume 10 No. 08
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Scientific Investigations

Assessing and Predicting the Likelihood of Interventions during Routine Annual Follow-up Visits for Management of Obstructive Sleep

http://dx.doi.org/10.5664/jcsm.3972

Srikant Nannapaneni, M.B.B.S., M.P.H.1; Timothy I. Morgenthaler, M.D., F.A.A.S.M.1,2; Kannan Ramar, M.B.B.S., M.D., F.A.A.S.M.1,2
1Division of Pulmonary and Critical Care Medicine and ; 2Center for Sleep Medicine, Mayo Clinic, Rochester, MN

Study Objectives:

Patients with obstructive sleep apnea (OSA) on established positive airway pressure (PAP) treatment are often advised routine annual follow-up visits to assess ongoing effectiveness and address problems associated with therapy. This study evaluates the clinical utility of annual face-to-face follow-up visits.

Design:

We performed a retrospective chart review of OSA patients on PAP who had completed a routine annual follow-up visit. Demographics, polysomnography, PAP compliance, Epworth Sleepiness Scale (ESS), subjective complaints (efficacy and interface issues, equipment malfunction, prescription renewal), objective findings (efficacy or leak issues, equipment problems), and visit-specific interventions were recorded. We determined relationships between patient provided information and likelihood of therapeutic versus administrative interventions.

Setting:

Academic sleep center.

Measurements and Results:

Among 716 patients who met study criteria, we abstracted data on 180 randomly selected patients. On multivariate analyses, only subjective complaints or objective findings by providers were associated with a therapeutic intervention (p < 0.0001). Though most patients (55 of 63 patients, 87.3%) who required therapeutic interventions had objective findings, without subjective complaints, the odds of such findings were only 0.12 (95% CI = 0.06-0.24, p < 0.0001). Without subjective complaints, the likelihood of a therapeutic intervention was 0.07 (95% CI = 0.03-0.15, p < 0.001).

Conclusion:

Our data suggests that in the absence of a subjective complaint, an annual follow-up is more likely to require administrative rather than face-to-face clinical intervention. Designing a clinic model to account for this might reduce resource utilization. However, the value and optimal timing of “routine” annual follow-up visits requires further evaluation.

Citation:

Nannapaneni S, Morgenthaler TI, Ramar K. Assessing and predicting the likelihood of interventions during routine annual follow-up visits for management of obstructive sleep. J Clin Sleep Med 2014;10(8):919-924.




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