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Comment and Response |

Management Setting of Obstructive Sleep Apnea

Jeremy A. Weingarten, MD1; Robert C. Basner, MD2
[+] Author Affiliations
1Division of Pulmonary and Critical Care Medicine, New York Methodist Hospital, Brooklyn
2Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
JAMA. 2013;310(1):96-97. doi:10.1001/jama.2013.7271.
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To the Editor In patients screened for moderate to severe OSA, Dr Chai-Coetzer and colleagues1 reported that management in a primary care setting was statistically noninferior to a specialist sleep center setting regarding change in subjective sleepiness measured by the Epworth Sleepiness Scale (ESS). There are several aspects of this study that we think should be highlighted.

Study withdrawal was 2- to 3-fold higher in the primary care vs sleep specialist groups, with almost half of the withdrawals in the primary care group due to CPAP intolerance. No patients in the sleep specialist group withdrew due to CPAP intolerance. The expertise of the sleep medicine specialist in improving CPAP adherence as well as adherence-related outcomes is well known.2 Also unexplained in the article is how shifting management from the sleep specialist to the primary care clinician would “… improve patient access to sleep services” or result in care “… delivered at a lower cost.”

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July 3, 2013
Ching Li Chai-Coetzer, MBBS, PhD; Nick A. Antic, MBBS, PhD; R. Doug McEvoy, MBBS, MD
1Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, South Australia
JAMA. 2013;310(1):97. doi:10.1001/jama.2013.7277.
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