Impact of a shift in treatment funding on a multidisciplinary sleep clinic: a cohort study
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ORIGINAL ARTICLE
Impact of a shift in treatment funding on a multidisciplinary sleep clinic: a cohort study Pierre Vermeire1 · Julien Fanielle2 · Yves Gilon3 · Caroline Pepinster4 · Valérie Quaedvlieg5 · Florence Rogister1 · Anne‑Lise Poirrier1 Received: 21 March 2020 / Accepted: 29 June 2020 © Belgian Neurological Society 2020
Abstract Multidisciplinary Sleep Clinics for sleep apnea have long existed, bringing together neurologists, sleep specialists, dentists, orthodontists and surgeons. In Belgium, a shift in funding for obstructive sleep apnea treatment was implemented from January 1st, 2017. Funding was allowed for moderate to severe obstructive sleep apnea and the rules shifted for treatments delivery and monitoring by authorised medical opinion. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann–Whitney U tests and descriptive statistics were produced. There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline obstructive sleep apnea severity was significantly lower (mean apnea–hypopnea index and mean oxygen desaturation index lowered with p = 0.0189 and p = 0.0466, respectively) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. The key changes of the new funding rules for obstructive sleep apnea were reflected in the patient selection and management by sleep multidisciplinary team meeting. Funding terms could influence the care we give, not only in treatment options, but also in patients selection. Keywords Sleep apnea · Continous positive airway pressure · Interdisciplinary study
Introduction Obstructive sleep apnea (OSA) is a highly prevalent syndrome, with moderate to severe sleep-disordered breathing affecting up to 23.4% women and 49.7% men [1]. More than a third of patients have difficulty using continuous positive airway pressure (CPAP), the gold standard of treatment for * Anne‑Lise Poirrier [email protected] 1
ENT Department, University Hospital of Liege, Sart‑Tilman B35, 4000 Liege, Belgium
2
Sleep–Wake Disorder Centre, Neurology Department, University Hospital of Liege, Liege, Belgium
3
Department of Maxillo‑Facial Surgery, University Hospital of Liege, Liege, Belgium
4
Department of Orthodontics, University Hospital of Liege, Liege, Belgium
5
Department of Respiratory Medicine, University Hospital of Liege, Liege, Belgium
OSA [2]. Alternative treatments include ENT, maxillofacial and bariatric surgery [3, 4], stimulating device implantation [5, 6] and oral appliance therapy [7, 8]. The key aspect of alternative treatments is selecting the appropriate one to tackle the specific anatomical issues in a given patient [3, 9]. There is recognition that management of
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