Postal Code Diagnosis and Treatment of Sleep Apnea

摘要: The Lung Centre, Vancouver, British Columbia Correspondence: Dr John A Fleetham, 7th Floor, 2775 Laurel Street, V5Z 1M9. Telephone 604-875-5653, fax 604-875-5587, e-mail john.fleetham@vch.ca In the current issue of Canadian Respiratory Journal, Rotenberg et al (1) (pages 170-174) report data from a crosssectional survey sent to otolaryngologists, respirologists and family physicians in Ontario, characterize wait times for obstructive sleep apnea (OSA) care. major finding was that patients with suspected OSA Ontario waited mean 11.6 months initiate continuous positive airway pressure (CPAP) treatment 16.2 surgical therapy. This is much longer than time Thoracic Society (CTS) guidelines, which recommend maximum two four weeks urgent comorbid disease or daytime sleepiness critical safety occupation, six all (2,3). Excessive diagnostic frequently lead inappropriate incorrect Wait diagnosis Canada have not improved since Flemons (4) reviewed five countries, including Canada, 16 years previously. To paraphrase what Pack (5) wrote an associated editorial: “It seems inconceivable we should tell patient following: You are highly likely severe apnea, disorder increased risk car crashes, high blood pressure, probably heart attack stroke. We effective this disorder. will arrange study you months’ assess this”. even reported by also merits comment. role corrective upper surgery controversial. CTS guidelines conclude laser-assisted uvulopalatoplasty recommended OSA, but uvulopalatopharyngoplasty may be considered selected who failed CPAP and/or oral appliance delay needs put context rest where provided very different manner. has highest number laboratories most other parts world apart United States (4). Moreover, one few provinces, along Manitoba Saskatchewan, provincial medical plan funds treatment. majority centres outside use ambulatory monitoring – addition polysomnography diagnose OSA. After been diagnosed, there no additional provision therapy because funded does require approval funding agency. respondents article identified ‘not enough laboratories’ as reason long times. Many would argue more required necessary appropriate strategy uses clinical prediction equations (6) conjunction fail improve Furthermore, if resources management rationed, higher priority given diagnosis. Patients health care services at approximately twice rate control subjects up 10 before (7). incremental cost-effectiveness ratio $2,618 per quality-adjusted life year over (8). less $10,000 qualityadjusted generally extremely cost effective. While many countries Kingdom (9) (10), it provinces. 2008, Association jointly under federal insurance plans adults children appropriately diagnosed OSA; however, little progress made past years. It now end postal code differences currently exist regard access editorial