All-inclusive sleep health resources to assist GPs

It is estimated that around 20% of the general adult population have moderate obstructive sleep apnoea (OSA), while around 30% report symptoms of sleep disturbance, including 10–15% who have symptoms suggestive of insomnia.
 
These rates suggest millions of Australians are struggling to get a good night’s sleep – but new consolidated evidence-based resources on sleep health promise to help primary care practitioners treat patients with these common issues.
 
According to Professor Nick Zwar, Executive Dean of Bond University and co-author of the online resources, the Sleep Health Primary Care Resources website is designed to give comprehensive guidance for the management of OSA and insomnia in general practice.
 
A chief investigator at the National Centre for Sleep Health Services Research (NCSHSR), Professor Zwar told newsGP the new resources provide GPs with appropriate clinical management, treatment and referral options for OSA and insomnia.
 
‘They support GPs in advising their patients on how to navigate the range of services and treatment options,’ he said.
 
‘They also help to upskill GPs to be more confident to provide that support … and this is the first time we’ve had something that is very carefully based in evidence and extensively reviewed by a range of experts.’
 
Reviewed by experts in respiratory and sleep medicine, primary care, psychology and pharmacy, as well as with the Australasian Sleep Association, the resources are modelled on the Australian asthma handbook and reflect contemporary best practice for sleep health.
 
They were also recently approved as an RACGP Accepted Clinical Resource.
 
The NCSHSR states that the clinical presentation of OSA is ‘very heterogeneous’, ranging from loud snoring, frequent episodes of apnoea and excessive daytime sleepiness, to those who are asymptomatic.
 
Between 30–50% of OSA patients report ‘clinically significant insomnia symptoms’, while around 30–40% of those with insomnia fulfil diagnostic criteria for OSA.
 
The combination of OSA and insomnia results in greater morbidity, according to the NCSHSR, including daytime impairments such as fatigue, lack of concentration and motivation, and depressive symptoms, compared to patients with either OSA or insomnia alone.
 
Professor Zwar said that due to the frequency of OSA and insomnia presentations and the associated ‘common problems’, the NCSHSR has worked to produce the resources to be easily searchable and user friendly.
 
‘The site provides summaries and stepwise processes for assessment and management of OSA and insomnia to help GPs navigate the process, and also options for investigation and referral,’ he said.
 
GPs can use three questionnaires to identify OSA and two questionnaires to identify insomnia, which will automatically score the patient to determine whether they are eligible for the Medicare rebate for direct referral for sleep study.
 
Eligible patients can access Medicare-funded sleep study services to clinically assess and diagnose sleep disorders, including OSA.
 
Statistics from 2019 show that around 133,000 patients received a Medicare diagnostic sleep study, and more than 21,100 patients received a Medicare treatment management sleep study service.
 
In the six months before or after their sleep study, the majority (between 93–98%) of patients visited a GP.
 
Professor Zwar said the living sleep health guidelines will ensure GPs are up to date in providing best practice care and tailored referral advice for patients to local health services.
 
‘For GPs sometimes it may not be easy to know what assessments to do and where to refer for a sleep study,’ he said.
 
‘We’re working with HealthPathways groups around the country to ensure they make use of these new resources to support this.’
 
The use of continuous positive airway pressure (CPAP) machines may be effective for management of OSA, but Professor Zwar said the expensive machines may not always stand the test of time, so it is important to explore all options.
 
‘There are quite strong commercial interests in selling CPAP machines for OSA,’ he said.
 
‘But [some patients] find them uncomfortable, then they have spent several thousand dollars on it and it sits idle, maybe because they haven’t had sufficient follow up and support, so that’s not ideal.
 
‘These resources will help GPs to support their patients to navigate those things, to know how to get the treatment that’s right for that patient and the care they need, and that there are other options as well as CPAP, including lifestyle advice and oral devices.’
 
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