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Grote L, Anderberg CP, Friberg D, Grundström G, Hinz K, Isaksson G, Murto T, Nilsson Z, Spaak J, Stillberg G, Söderberg K, Tegelberg Å, Theorell-Haglöw J, Ulander M, Hedner J. National Knowledge-Driven Management of Obstructive Sleep Apnea-The Swedish Approach. Diagnostics (Basel) 2023; 13:diagnostics13061179. [PMID: 36980487 PMCID: PMC10047173 DOI: 10.3390/diagnostics13061179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION This paper describes the development of "Swedish Guidelines for OSA treatment" and the underlying managed care process. The Apnea Hypopnea Index (AHI) is traditionally used as a single parameter for obstructive sleep apnea (OSA) severity classification, although poorly associated with symptomatology and outcome. We instead implement a novel matrix for shared treatment decisions based on available evidence. METHODS A national expert group including medical and dental specialists, nurses, and patient representatives developed the knowledge-driven management model. A Delphi round was performed amongst experts from all Swedish regions (N = 24). Evidence reflecting treatment effects was extracted from systematic reviews, meta-analyses, and randomized clinical trials. RESULTS The treatment decision in the process includes a matrix with five categories from a "very weak"" to "very strong" indication to treat, and it includes factors with potential influence on outcome, including (A) OSA-related symptoms, (B) cardiometabolic comorbidities, (C) frequency of respiratory events, and (D) age. OSA-related symptoms indicate a strong incitement to treat, whereas the absence of symptoms, age above 65 years, and no or well-controlled comorbidities indicate a weak treatment indication, irrespective of AHI. CONCLUSIONS The novel treatment matrix is based on the effects of treatments rather than the actual frequency of respiratory events during sleep. A nationwide implementation of this matrix is ongoing, and the outcome is monitored in a prospective evaluation by means of the Swedish Sleep Apnea Registry (SESAR).
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Affiliation(s)
- Ludger Grote
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Pulmonary Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | | | - Danielle Friberg
- Department of Otorhinolaryngology, Surgical Sciences, Uppsala University, 752 36 Uppsala, Sweden
| | - Gert Grundström
- Sleep Apnea Patient Organisation (Apne Sverige), 13332 Saltsjoebaden, Sweden
| | - Kerstin Hinz
- Department for Health Care Development, Region of Västra Götaland, 40544 Gothenburg, Sweden
| | | | - Tarmo Murto
- Sleep Apnea Unit, Respiratory Medicine, Umeå University Hospital, 90185 Umeå, Sweden
| | - Zarita Nilsson
- Sleep Apnea Unit, ENT Department, Ystad Hospital, 271 82 Ystad, Sweden
| | - Jonas Spaak
- Department of Cardiology and Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, 18288 Danderyd, Sweden
| | | | - Karin Söderberg
- Sleep Apnea Patient Organisation (Apne Sverige), 13332 Saltsjoebaden, Sweden
| | - Åke Tegelberg
- Sleep Apnea Patient Association (Apnefoereningen Syd), 14630 Tullinge, Sweden
| | | | - Martin Ulander
- Department for Clinical Neurophysiology, 58185 Linköping, Sweden
| | - Jan Hedner
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Pulmonary Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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