Redesigning Care for OSA

• Published in: Chest Vol. 157; no. 4; pp. 966 - 976
• Main Authors: Donovan, Lucas M., Shah, Aditi, Chai-Coetzer, Ching Li, Barbé, Ferran, Ayas, Najib T., Kapur, Vishesh K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2020; American College of Chest Physicians
• Subjects: CHEST Review; home sleep apnea testing; hub and spoke; Humans; Needs Assessment; nonspecialist-led care; OSA; Patient Care Management - methods; Patient Care Management - trends; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - therapy; stepped care; hub and spoke; PTSD; MAD; ASV; ECHO; PSG; nonspecialist-led care; stepped care; OSA; home sleep apnea testing; PAP
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2019.10.002

Constrained by a limited supply of specialized personnel, health systems face a challenge in caring for the large number of patients with OSA. The complexity of this challenge is heightened by the varied clinical presentations of OSA and the diversity of treatment approaches. Innovations such as simplified home-based care models and the incorporation of nonspecialist providers have shown promise in the management of uncomplicated patients, producing comparable outcomes to the resource-intensive traditional approach. However, it is unclear if these innovations can meet the needs of all patients with OSA, including those with mild disease, atypical presentations, and certain comorbid medical and mental health conditions. This review discusses the diversity of needs in OSA care, the evidence base behind recent care innovations, and the potential limitations of each innovation in meeting the diversity of care needs. We propose how these innovations can fit within the stepped care and hub and spoke models in a way that addresses the full spectrum of OSA, and we discuss future research directions to assess the deployment of these innovations.