Organisation of diagnosis and treatment of obstructive sleep apnoea syndrome: an international comparison

140 p.ill.,SCIENTIFIC REPORT 12 -- 1 INTRODUCTION 12 -- 1.1 RATIONALE 12 -- 1.2 SCOPE 13 -- 1.3 METHODS 13 -- 2 OVERVIEW OF EVIDENCE ON OSAS 15 -- 2.1 DEFINITION OF OSAS 15 -- 2.2 EPIDEMIOLOGY 17 -- 2.2.1 Prevalence 17 -- 2.2.2 Association between AHI and clinical outcomes 18 -- 2.3 DIAGNOSIS OF OSAS 20 -- 2.3.1 Screening for OSAS 20 -- 2.3.2 Polysomnography-based diagnosis 20 -- 2.3.3 HSAT-based diagnosis 21 -- 2.4 TREATMENT OF OSAS 30 -- 2.4.1 Positive Airway Pressure 30 -- 2.4.2 Home-based APAP versus in-laboratory PAP titration for initiation of PAP 33 -- 2.4.3 PAP versus other treatments for OSAS 34 -- 2.4.4 Telemonitoring of PAP 37 -- 2.4.5 Management of OSA in primary care vs sleep unit setting 37 -- 2.4.6 Discussion 38 -- 2.5 COST-EFFECTIVENESS OF TREATMENT WITH PAP OR MAD 40 -- 2.6 COST-EFFECTIVENESS OF HOME-BASED VERSUS HOSPITAL-BASED STRATEGIES 42 -- 3 INTERNATIONAL COMPARISON 50 -- 3.1.1 Screening by questionnaires 50 -- 3.1.2 Home-based diagnosis 51 -- 3.2.1 Lifestyle recommendations 54 -- 3.2.2 PAP versus other treatment 55 -- 3.2.3 Titration of PAP 55 -- 3.2.4 Follow-up of treatment 55 -- 3.3.1 Belgium 61 -- 3.3.2 France 62 -- 3.3.3 Finland 64 -- 3.3.4 Germany 65 -- 3.3.5 The Netherlands 66 -- 3.3.6 England 68 -- 3.4 INVOLVEMENT OF SERVICE PROVIDERS 69 -- 3.5 ACCREDITATION OF SPECIALISTS IN SLEEP MEDICINE AND OF SLEEP LABS 70 -- 4 ANALYSIS OF THE EPS DATABASE 75 -- 4.1 METHOD 75 -- 4.2 ANALYSIS 75 -- 4.2.1 Number of patients 75 -- 4.2.2 Diagnostic procedure 79 -- 4.2.3 During the convention 83 -- 4.2.4 Titration procedure 84 -- 4.2.5 Follow-up period 84 -- 5 FINANCING RULES FOR THE MANAGEMENT OF OSAS PATIENTS 86 -- 5.1 DIAGNOSIS 86 -- 5.2 TITRATION AND TREATMENT 89 -- 5.2.1 PAP 89 -- 5.2.2 MAD 93 -- 5.3 BUDGET ALLOCATED TO THE OSAS CONVENTION 97 -- 6 SCENARIOS 100 -- 6.1 HOME SLEEP APNOEA TESTING (HSAT) 100 -- 6.1.1 Rationale 100 -- 6.1.2 Supportive evidence 100 -- 6.1.3 Points of attention 101 -- 6.2 HOME-BASED TITRATION (HBT) OF PAP 101 -- 6.2.1 Rationale 101 -- 6.2.2 Supportive evidence 102 -- 6.2.3 Points of attention 102 -- 6.3 QUALITY IS PROMOTED AT ALL LEVELS OF CARE 103 -- 6.3.1 Rationale 103 -- 6.3.2 Supportive evidence 103 -- 6.3.3 Points of attention 103 -- 6.4 AN INTEGRATED CARE PATHWAY IS DEFINED AND EFFECTIVE 104 -- 6.4.1 Rationale 104 -- 6.4.2 Supportive evidence 104 -- 6.4.3 Points of attention 104 -- 6.5 FUNDING MECHANISMS ARE ADAPTED 105 -- 6.5.1 Rationale 105 -- 6.5.2 Supportive evidence 105 -- 6.5.3 Points of attention 106 -- 6.6 TELEMONITORING IS USED IN A SUBSTANTIAL PROPORTION OF PATIENTS 106 -- 6.6.1 Rationale 106 -- 6.6.2 Supportive evidence 106 -- 6.6.3 Points of attention 106 -- 7 BUDGET IMPACT OF THE OSAS ORGANISATIONAL SCENARIOS 107 -- 7.1 HOME SLEEP APNOEA TESTING 107 -- 7.2 HOME-BASED TITRATION WITH APAP 109 -- 7.3 PAP FOLLOW-UP PERFORMED BY PRIVATE SERVICE PROVIDERS OUTSIDE THE OSAS CONVENTION 111 -- REFERENCES 113 -- APPENDICES 12