title: Effect of a targeted obstructive sleep apnea consult to improve access and quality at a sleep disorders center.
abstract: OBJECTIVE
  We sought to evaluate whether a targeted obstructive sleep apnea (OSA) consult (TOSAC) protocol that reduced sleep-specialist time spent with patients suspected of having OSA would improve quality of care compared with the previous clinical method for evaluation of patients internally referred for suspected OSA.
  
  
  METHODS
  Prospective cohort design. TOSAC patients received oximetry and criteria screening prior to a split-night polysomnography and a 45-minute sleep-specialist consult, while control patients received consult, testing, and a follow-up visit (90 minutes of sleep-specialist time).
  
  
  RESULTS
  We enrolled 186 TOSAC and 94 control patients. TOSAC patients completed their evaluation in a median of 7.0 days compared with 60.0 days for the controls (p < .001). At baseline, the TOSAC group was sleepier (Epworth Sleepiness Scale 13.9+/-4.5 vs 11.0+/-4.3; p < .001) and had a slightly lower quality of life (Functional Outcomes of Sleep Questionnaire 15.0+/-3.0 vs 16.8+/-2.2, p < .001) than controls. The apnea-hypopnea index noted at polysomnography was similar in TOSAC and control patients (28.6+/-29.5 vs 23.1+/-23.9, p = .156), and the prevalence of OSA was similar in both groups (75% vs 72%, p = .616). At 1 month of therapy, improvement in the Epworth Sleepiness Scale and overall patient satisfaction were similar between groups (all p > .10), while TOSAC patients had a slightly greater improvement on the Functional Outcomes of Sleep Questionnaire (p = .010). TOSAC patients reported better subjective continuous positive airway pressure compliance (median 42.0 vs 32.5 hours/week; p = .037).
  
  
  CONCLUSIONS
  A protocol-driven evaluation pathway for OSA that used screening with oximetry and less sleep-specialist time shortened access and produced similar diagnoses, improvements in sleepiness and quality of life, and overall satisfaction.
authors.affiliation: Mayo Clinic Sleep Disorders Center, 200 First Street SW, Rochester, MN 55905, USA. tmorgenthaler@mayo.edu
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Olson
authors.forename: Peter
authors.initials: P
authors.lastname: Gay
authors.forename: Paul A
authors.initials: PA
authors.lastname: Decker
authors.forename: Dan
authors.initials: D
authors.lastname: Herold
authors.forename: Wendy
authors.initials: W
authors.lastname: Moore
authors.forename: Michael H
authors.initials: MH
authors.lastname: Silber
authors.forename: Lois
authors.initials: L
authors.lastname: Krahn
mesh_terms: D015992:Body Mass Index; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006296:Health Services / Q000592:standards*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D017286:Polysomnography; D011446:Prospective Studies; D012017:Referral and Consultation; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires