title: Assessing and predicting the likelihood of interventions during routine annual follow-up visits for management of obstructive sleep.
abstract: OBJECTIVE
  Patients with obstructive sleep apnea (OSA) on established positive airway pressure (PAP) treatment are often advised routine annual follow-up visits to assess ongoing effectiveness and address problems associated with therapy. This study evaluates the clinical utility of annual face-to-face follow-up visits.
  
  
  METHODS
  We performed a retrospective chart review of OSA patients on PAP who had completed a routine annual follow-up visit. Demographics, polysomnography, PAP compliance, Epworth Sleepiness Scale (ESS), subjective complaints (efficacy and interface issues, equipment malfunction, prescription renewal), objective findings (efficacy or leak issues, equipment problems), and visit-specific interventions were recorded. We determined relationships between patient provided information and likelihood of therapeutic versus administrative interventions.
  
  
  METHODS
  Academic sleep center.
  
  
  RESULTS
  Among 716 patients who met study criteria, we abstracted data on 180 randomly selected patients. On multivariate analyses, only subjective complaints or objective findings by providers were associated with a therapeutic intervention (p < 0.0001). Though most patients (55 of 63 patients, 87.3%) who required therapeutic interventions had objective findings, without subjective complaints, the odds of such findings were only 0.12 (95% CI = 0.06-0.24, p < 0.0001). Without subjective complaints, the likelihood of a therapeutic intervention was 0.07 (95% CI = 0.03-0.15, p < 0.001).
  
  
  CONCLUSIONS
  Our data suggests that in the absence of a subjective complaint, an annual follow-up is more likely to require administrative rather than face-to-face clinical intervention. Designing a clinic model to account for this might reduce resource utilization. However, the value and optimal timing of "routine" annual follow-up visits requires further evaluation.
authors.affiliation: Division of Pulmonary and Critical Care Medicine and.
authors.forename: Srikant
authors.initials: S
authors.lastname: Nannapaneni
authors.affiliation: Division of Pulmonary and Critical Care Medicine and ; Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
authors.affiliation: Division of Pulmonary and Critical Care Medicine and ; Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Kannan
authors.initials: K
authors.lastname: Ramar
mesh_terms: D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010349:Patient Compliance; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: CPAP; clinic visits; complaints; follow-up; obstructive sleep apnea