Direct Referral for Apnea Monitoring

Study Overview
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Brief Summary
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The primary objective of this project is to compare a health care delivery model, Direct Referral for Apnea Monitoring (DREAM), with initial in-person (Traditional) clinic appointments for Veterans at risk for obstructive sleep apnea (OSA). A secondary objective is to determine the negative predictive value (NPV) of home sleep apnea testing (HSAT).

Detailed Description
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Patients referred to one of 3 participating VA sleep medicine clinics (San Francisco VA, VA Portland or VA Pittsburgh) for OSA will be assigned either to the Traditional clinical pathway (which might include an initial encounter with a sleep care provider through in-person visits, telephone clinics, or video conferencing) or the DREAM pathway which will omit the initial encounter with a care provider. After a clinician conducts a chart review of medical records, patients in the DREAM pathway will be referred for sleep testing. All patients will be tracked from the time of referral until 90-days past the initiation of treatment. To determine the NPV of HSAT, results of sleep tests will be compared for patients who undergo both HSAT and polysomnographic (PSG) procedures.

Official Title
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Improving Access to Sleep Apnea Care: A Pragmatic Study of New Consultation Models

Conditions
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Obstructive Sleep Apnea (OSA)

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 years Agrees to be seen by a VA sleep program Reason for referral to sleep clinic: New OSA Evaluation Exclusion Criteria: Age < 18 years Declines to be seen by a VA sleep program Reason for referral to sleep clinic: anything other than a new OSA evaluation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Traditional clinical pathway for OSA<br>After referral, patients will have an initial encounter with a sleep care provider which might include in-person visits, telephone clinics, or video conferencing. Intervention/Treatment: Patients in Arm 1 will receive routine care for OSA at one of the participating VA Sleep Medicine clinics. | |
| DREAM clinical pathway for OSA<br>After referral, patients will not have an initial encounter with a care provider. After a clinician conducts a chart review of medical records, patients in the DREAM pathway will be referred for sleep testing. Intervention/Treatment: Patients in Arm 2 will receive routine care for OSA at one of the participating VA Sleep Medicine clinics. | |
| Negative predictive value of HSAT<br>Results of sleep tests will be compared for patients who undergo both HSAT and polysomnographic (PSG) procedures. Intervention/Treatment: Patients in Arm 3 will undergo a) HSAT sleep testing followed by PSG testing, or b) simultaneous administration of PSG and HSAT sleep testing. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time from referral | For Arms 1 & 2: Compare time from referral to sleep testing and treatment of OSA | 1 year | 
| PAP adherence | For Arms 1 & 2: PAP treatment adherence (for example, Percentage of days with usage >= 4 hours) between Traditional and DREAM clinical pathways | 1 year | 
| AHI scores | For Arm 3: Compare apnea-hypopnea index (AHI) scores between HSAT and PSG procedures | 4 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sleep apnea syndromes, polysomnography