The project arose in 2014 from concerns by Dr. Ramon Orriols, head of the Pneumonology Department of the Hospital Universitari Dr. Josep Trueta in Girona, and his medical team, who regarded the underdiagnosis of sleep apnea as “a medical problem of the highest magnitude.” Thus, the team of pneumonologists began working with the basic health areas (ABSs) under the umbrella of the two hospitals in order to start diagnosing sleep apnea from the primary care level.
From 2014 to 2016 a pilot trial was carried out, led by Dr. Èric Rojas, a pneumonologist from the Sleep Unit at the Trueta and Santa Caterina Hospitals. The premise of this project was that 80% of people at some point in their lives are treated at a primary care center. Moreover, the main users of these resources – patients with a high prevalence of diabetes, high blood pressure and obesity – are also the ones who are most likely to suffer from sleep apnea. Therefore, it was deemed that primary care centers are the ideal setting in which to diagnose this pathology.
The study involved comparing the automatic diagnosis of obstructive sleep apnea obtained by means of nocturnal home pulse oximetry and home respiratory polygraphy, which was then assessed by the corresponding primary care doctors, with the manual diagnosis of the respiratory polygraphy and the full polygraphy procedures carried out by the pneumonologist within the hospital setting.
The study focused on two ABSs that have Trueta as a referral hospital (Sarrià de Ter and Santa Clara) and two ABSs that have the Hospital de Santa Caterina as a referral hospital (Sils and Salt). A total of 599 patients were randomly selected, of which 97 finally participated in the study. 61% of these patients were men, with an average age of 57, all with class 1 obesity and most of them ex-smokers.
The pilot study proved that 98.8% of the polygraph results obtained automatically coincided with those obtained manually by the pneumonologists, demonstrating a positive diagnosis of obstructive sleep apnea. With regard to severity, there was a coincidence in 95% of the cases in which the primary care physician indicated that the case was serious.
The findings of the study indicated that obstructive sleep apnea can be diagnosed in the primary care setting and that automatic analysis facilitates the diagnosis of obstructive apnea, especially when it is severe. These results were shared in several national and international congresses. In 2017 the project “Diagnosis of obstructive sleep apnea syndrome in Primary Care in the health area of Girona (Obrador-Orriols) was presented at the INNOBICS platform of the Catalan Institute of Health, and the executive council of the Catalan Institute of Health validated the pilot phase a year later. The positive reception of the project encouraged the researchers involved to submit it to EIT Health.
