Evaluation of an Early Management Strategy for Obstructive Sleep Apnea

Evaluation of an Early Management Strategy for Obstructive Sleep Apnea: A Randomized Trial

The primary objective of this study is to evaluate the effect of more timely care for obstructive sleep apnea (OSA) on adherence to positive airway pressure (PAP) therapy at three months after treatment initiation. The secondary objectives are to determine if earlier care improves the treatment effect of PAP on patient reported sleepiness, quality of life and patient satisfaction. We will also evaluate the impact of shorter wait times on patient engagement in therapy by assessing initial acceptance of PAP therapy, patient activation and self-efficacy with respect to OSA treatment.

The study hypothesis is that the early management strategy will be superior to usual care with respect to the primary outcome of PAP adherence at three months.

Inclusion Criteria:

• HSAT ODI >= events/hr and ESS 10 - 15 OR
• HSAT ODI 15 - 30 and ESS 15 or lower

Exclusion Criteria:

• Severe nocturnal hypoxemia on HSAT (mean oxygen saturation by pulse oximetry (SpO2) ≤ 85%)
• Severe hypersomnolence (Epworth Sleepiness Scale score ≥ 16)
• Employed in safety-critical occupation
• Recent motor vehicle collision reported on screening questionnaire (within one year)
• Severe hypertension requiring ≥ three antihypertensive medications
• Recent admission to hospital due to unstable cardiopulmonary disease (within 30 days)
• Upcoming major surgery (within six months)
• Prior history of OSA treatment
• Significant co-morbid sleep disorder that would interfere with PAP acclimatization and adherence (e.g., severe insomnia, restless leg syndrome)