Study protocol to assess de-implementation of the initial provider encounter for diagnosis and treatment of obstructive sleep apnea: the DREAM (Direct Referral for Apnea Monitoring) Project.
Study protocol to assess de-implementation of the initial provider encounter for diagnosis and treatment of obstructive sleep apnea: the DREAM (Direct Referral for Apnea Monitoring) Project.
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DOI：
10.1186/s12890-022-01899-y
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发表时间：
2022-04-02
影响因子：
3.1
通讯作者：
Sarmiento KF
中科院分区：
文献类型：
--
作者：
Folmer RL;Boudreau EA;Atwood CW;Smith CJ;Totten AM;Tock JL;Chilakamarri P;Sarmiento KF
阻塞性睡眠呼吸暂停(OSA)是一种非常常见和严重的健康状况，在美国退伍军人中非常普遍。由于对睡眠药物服务的需求往往超过了此类服务的可获得性，因此有必要简化诊断和治疗方案。这项研究的目标是：(1)评估取消诊断和治疗阻塞性睡眠呼吸暂停综合征(OSA)的初始提供者接触的有效性；(2)确定家庭睡眠呼吸暂停测试(HSAT)的阴性预测值(NPV)；(3)为各种高危患者群体制定HSAT使用建议。这是一项大型、务实的研究，将在3个退伍军人管理局睡眠医学项目中进行：加利福尼亚州旧金山；俄勒冈州波特兰；以及宾夕法尼亚州匹兹堡。所有在这些地点接受新的睡眠呼吸暂停评估的退伍军人都将被纳入这项为期四年的研究。结果将包括从转诊到睡眠测试和治疗的时间；正压(PAP)治疗依从性衡量标准；患者报告的临床结果和满意度衡量标准；HSAT净现值的确定；高危患者群体的HSAT使用建议。DREAM(睡眠呼吸暂停监测直接转诊)项目将向睡眠药物提供商和临床组织通报有关简化OSA诊断和治疗方案的战略。这项研究的结果应该对临床实践和专业指南产生重大影响。试验注册这个项目的大部分是对临床程序的观察性研究。因此，临床试验注册不是必需的。网上版载有补充材料，可在10.1186/s12890-022-01899-y查阅。
Obstructive sleep apnea (OSA) is a very common and serious health condition which is highly prevalent among U.S. military Veterans. Because the demand for sleep medicine services often overwhelms the availability of such services, it is necessary to streamline diagnosis and treatment protocols. The goals of this study are to, (1) assess the efficacy of de-implementing the initial provider encounter for diagnosis and treatment of OSA; (2) determine the negative predictive value (NPV) of home sleep apnea testing (HSAT); (3) develop HSAT usage recommendations for various at-risk patient populations. This is a large, pragmatic study that will take place in 3 VA sleep medicine programs: San Francisco, CA; Portland, OR; and Pittsburgh, PA. All Veterans referred for new sleep apnea evaluations at these sites will be included in this four-year study. Outcomes will include time from referral for OSA to sleep testing and treatment; positive airway pressure (PAP) treatment adherence measures; patient-reported clinical outcomes and measures of satisfaction; determination of the NPV of HSAT; HSAT usage recommendations for at-risk patient populations. The DREAM (Direct Referral for Apnea Monitoring) Project will inform sleep medicine providers and clinical organizations regarding strategies to streamline diagnosis and treatment protocols for OSA. Results of this study should have significant impact on clinical practices and professional guidelines. Trial registration The majority of this project is an observational study of clinical procedures. Therefore, clinical trial registration is not required. The online version contains supplementary material available at 10.1186/s12890-022-01899-y.
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