Search

Background and Objectives The national French Registry to evaluate sleep breathing disorders (OSFP Registry: Observatoire sommeil de la Federation de Pneumologie) is intended to collect updated information about current practices of respiratory physicians managing sleep apnoea patients. Methods, Program Description and Follow-up The main goal of the Internet-based registry (www.osfp.fr) is to improve clinical management quality by offering respiratory physicians a complete and systematically organised online evaluation of patients referred for sleep disorders. The content of the registry addresses four goals: (1) to improve physician9s knowledge not only of sleep apnoea but also of alternative diagnosis by the systematic use of validated clinical scales for sleepiness, fatigue, depression and restless legs syndrome, (2) to increase awareness of comorbidities and cardio-metabolic risk associated with sleep apnoea, by suggesting measurements of waist circumference, blood pressure, fasting lipids and fasting glucose, (3) to identify subgroups of at-risk patients (ie obesity hypoventilation and a combination of chronic obstructive pulmonary disease and sleep apnoea, the so-called overlap syndrome), and (4) to suggest appropriate follow-up and treatments for these specific subgroups of patients according to national guidelines. Information from the database is available at anytime and data can be extracted for statistical analysis. Participating physicians can compare their practices with others’ in the registry and with the guidelines established with the French High Health authority (HAS: Haute Autorite de Sante). Results in terms of clinical impact More than 560 centres were involved and between January 2007 and November 2009, more than 22 000 suspected sleep apnoea patients were enrolled. These centres included varied clinical practices, reflecting real life sleep apnoea clinical management in France. The majority of centres were private practices (74% of the patients) whilst others were public hospital practices, either teaching university hospitals (4% of the patients) or district hospitals (22% of the patients). Patients from all regions of France were included and constitute a representative sample in terms of places of residence, rural/urban ratio and socio-professional groups. Sleep apnoea was diagnosed in 80% of referred patients and CPAP prescribed in 70% of them, with a mean CPAP usage of 5.7 h/night which is higher than the usually reported compliance in clinical studies (Cochrane 2009: 5.5 h/night). Significant improvement occurred with reduction in the sleepiness, fatigue and depression scales (from 12 to 8, 14 to 9 and 6 to 4.5, respectively). Appropriate characterisation of the patients at baseline allowed the identification of cardiovascular comorbidities in 45% of the patients. A significant percentage of patients (11%) were referred to cardiologist or other specialists after associated or alternative diagnosis had been appropriately recognised. To date, 50% of obese patients underwent blood gases and pulmonary function testing. Obesity hypoventilation syndrome was then diagnosed in 11.8 % of these obese subjects, leading to a prescription of CPAP or noninvasive ventilation in the most severe cases. Abnormal pulmonary function tests during the baseline evaluation led to implement bronchodilator medications in 2.8% of the investigated patients. Discussion and Conclusion This quality control program using an Internet-based registry allows the description of key demographic characteristics of patients referred for sleep disorders as well as an evaluation of current practices and treatment management of sleep apnea patients by respiratory physicians in France. This system aims to prompt respiratory physicians to use wide-ranging diagnostic tools when evaluating and following sleep disorder patients. Caregivers can compare their own practices and current guidelines. For the patients, comorbidities, both respiratory and nonrespiratory, are more systematically identified and appropriately addressed. Finally, the registry is an appropriate tool to assess the usefulness of guidelines across the country and improve patient care. Contexte Et Objectifs L9Observatoire sommeil de la Federation de Pneumologie (OSFP) collecte, a partir d9une saisie internet, des informations sur les pratiques des pneumologues en termes de diagnostic et de gestion therapeutique du syndrome d9apnees du sommeil. Programme Description, mise En oeuvre, suivi L9objectif principal de ce registre via internet (www.osfp.fr) est d9ameliorer la qualite de la prise en charge des patients en proposant aux pneumologues participants de realiser une evaluation plus complete et systematiquement organisee de leurs patients. L9observatoire poursuit quatre objectifs permettant une amelioration de la qualite : (i) Augmenter la connaissance des praticiens non seulement concernant le syndrome d9apnees du sommeil mais aussi concernant les diagnostics differentiels ou associes. Pour cela il leur est propose une utilisation systematique d’echelles cliniques validees de somnolence, de fatigue, de depression et de severite du syndrome des jambes sans repos. (ii) Elargir le bilan a la recherche de co-morbidites de la maladie et documenter le risque cardiovasculaire en realisant une mesure de la pression arterielle, du perimetre ombilical et un bilan biologique. (iii) Inciter a l9identification des sous groupes de patients a risque eleve de complications et de mortalite (Obeses hypoventilateurs ou association entre une BPCO et un syndrome d9apnees du sommeil) , (iv) proposer et organiser un suivi et un traitement approprie pour ces differents sous-groupes de patients en accord avec les recommandations nationales. A partir d9analyses statistiques disponibles en permanence, les praticiens participants a l9observatoire peuvent a tout moment comparer leurs pratiques avec celles des autres centres et avec les recommandations de pratique clinique en cours d’elaboration avec la Haute Autorite de Sante. Resultats En Termes D9impact clinique Plus de 560 centres participent a l9observatoire et entre 01/2007 et 11/2009 plus de 22 000 patients suspects d’etre porteurs d9un syndrome d9apnees du sommeil ont ete inclus dans le registre. Les centres participants correspondent a des modes d9exercice varies refletant la « vrai vie » de la prise en charge du syndrome d9apnees du sommeil en France (Pratique liberale, hopitaux generaux et universitaires pour respectivement 74, 22 et 4% des patients). Les patients proviennent de toutes les regions francaises et constituent un echantillon representatif en terme de lieu de residence, habitat rural/urbain et repartition des categories socioprofessionnelles. Un syndrome d9apnees du sommeil a ete diagnostique chez 80% des patients et une pression positive continue proposee a 70% d9entre eux avec une utilisation moyenne de 5,7 heures/nuit ce qui est superieur a l9observance rapportee dans les etudes cliniques (Cochrane 2009: 5,5 heures/nuit). Des ameliorations cliniques etaient constatees avec une reduction significative des scores de somnolence, fatigue et depression (de 12 a 8, 14 a 9 et 6 a 4,5 respectivement). Caracteriser precisement les patients lors de l’evaluation initiale a permis de retrouver des comorbidites cardiovasculaires dans 45% des cas. 11% des patients ont ete adresses au cardiologue ou a un autre specialiste car le bilan initial avait permis d9identifier des diagnostics associes. Un syndrome obesite hypoventilation a ete diagnostique chez 11,8 %, ceci permettant dans les cas les plus severes d9orienter les patients vers une ventilation non-invasive. Les tests fonctionnels respiratoires ont conduit a debuter un traitement bronchodilatateur chez 2,8% des patients. Discussion-conclusions Ce programme d’evaluation des pratiques reposant sur un registre internet permet d9ameliorer la qualite de gestion du syndrome d9apnees du sommeil directement profitable au malade tout en disposant de donnees epidemiologiques. Ce mode de fonctionnement invite les praticiens a utiliser des outils diagnostiques et d’evaluation au-dela de leur propre specialite. L9impact pour les patients est une meilleure reconnaissance des co-morbidites, des pathologies associees ceci permettant une prise en charge plus efficiente.