Comparison among three different follow-up models for obstructive sleep apnea syndrome patients: focus on the physiotherapist's role.

Abstract

In obstructive sleep apnea syndrome (OSAS) subjects, different follow-up modalities have been proposed to improve adherence to the continuous positive airway pressure (CPAP) device. This retrospective study compares three different health professional approaches dedicated to caring for OSAS patients in three consecutive follow-up periods of 15 months each. The three different follow-up models are i) physician-oriented follow-up (P-F), ii) physiotherapist-oriented follow-up (PT-F), and iii) tele-titration plus PT-oriented follow-up (TT-PT-F). Health personal visits and actions delivered, patients' adherence, CPAP efficacy, and problems under CPAP use were considered for comparison. Data from 122 OSAS patients with a new prescription of CPAP were analyzed: 39 (32.0%) in the P-F, 38 (31.1%) in the PT-F, and 45 (36.9%) in the TT-PT-F period. We found a reduction over time (from 40.9% in P-F to 8.2% in TT-PT-F, p<0.001) in patients missing the 1-year follow-up visit. The PT-F and TT-PT-F lead to a reduction in physician visits in comparison to P-F (5.2% and 8.9% vs. 100%, p<0.001) with no differences in time to the first follow-up visit, CPAP efficacy, and patients' adherence among the three periods. More device-related problems were found in the PT-F (57.8%), compared with the PF (25.6%) period (p<0.001); the most common troubles were mask problems evaluated in 26.2% of cases. In conclusion, different follow-up models offer similar efficacy and short-term adherence for CPAP, leading to a significant reduction in physician visits under the PT-F with or without tele-titration, with mask problems as the most commonly treated. Further analysis should be useful to define the best cost-efficacy follow-up intervention.