Sleep apnoea effectively diagnosed in primary care, study finds

Using an autoscoring home-testing device, primary care providers were able to diagnose severe obstructive sleep apnoea with an exceptionally high level of diagnostic agreement with hospital assessments, a new study has found.

The study, which was published in npj Primary Care Respiratory Medicine, was conducted at four primary care centres in Spain between 2016 and 2020 and set out to see whether obstructive sleep apnoea could be accurately diagnosed in primary care without the involvement of a hospital sleep specialist.

The researchers compared diagnoses made by primary care physicians using an autoscoring home sleep apnoea testing device – ApneaLink Air – against hospital assessments, that included manual home sleep apnoea testing and polysomnography.

The study included 329 patients aged 30–70 years who had all been identified as having a high probability of obstructive sleep apnoea based on a questionnaire completed during a routine GP visit at one of four primary care centres.

The most clinically significant findings of the study were that severe obstructive sleep apnoea showed an exceptionally high level of diagnostic agreement between primary care centres and the hospital – at 96.2% – with the ApneaLink Air device demonstrating high specificity for severe obstructive sleep apnoea in a high-risk primary care population.

By contrast, overall diagnostic agreement fell to 41.6% when accounting for all severities of obstructive sleep apnoea. The poor concordance for mild and moderate cases indicates that patients with non-severe forms of the condition will likely still require specialist assessment.

The authors conclude that using the home-testing ApneaLink Air device in primary care is reliable for identifying severe obstructive sleep apnoea, potentially enabling earlier treatment and avoiding the delays associated with hospital referral.

Moreover, the study authors highlight that the training required for health-care providers to use this approach is minimal — a few hours of theoretical and practical instruction — making it realistic to implement in everyday primary care settings.

The authors suggest this approach could be particularly valuable in rural or remote areas, or in healthcare systems where sleep clinics are overstretched and waiting times are long.