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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Katrina Miriam Regnauld, Dr, Sue Payne, Dr, Peter Donnelly, MD MPH MBA FRCP, Julie D Clark, BSc MPH, and Carole A. Morris. Public Health, Lothian NHS Board, Deaconess House, 148 Pleasance, Edinburgh, United Kingdom
Ediburgh’s Sleep Centre mainly treats individuals with moderate and severe obstructive sleep apnoea (OSA) by CPAP (continuous positive airway pressure) machines.
In 1996 this service was devolved from the National Service Division. Finances were distributed on a per capita, not usage basis, leaving SE Scotland's Health Boards with a financial shortfall. Moreover, the purchase and maintenance costs of CPAP machines are met by the service itself and are continually escalating. In the light of financial pressures, the Sleep Centre’s efficacy was investigated.
A literature review and a randomised, retrospective audit of the sleep centre's practice, evaluating its adherence to local protocol and draft Scottish Intercollegiate Guidelines Network (SIGN) guidelines (through 173 case notes), were conducted.
The literature review indicates that CPAP is an effective treatment for people with severe, but not mild, OSA. It's efficacy for people with moderate OSA and the threshold for benefit is open to question. Moreover, many of the trails published to date have methodological weaknesses, undermining their reliability. These problems make it difficult to draw firm conclusions about appropriate treatment. Restricting provision to people with severe OSA could reduce treatment costs, though risks withholding benefits from those who may benefit.
The audit confirmed that the sleep centre was adhering to local protocol and draft SIGN guidelines.
Financial pressures are currently being tackled by integrating the sleep centre into normal funding procedures, and attempting to fund CPAPs from prescription budgets.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.