Intra- and Inter-Physician Agreement in Therapeutic Decision for Sleep Apnea Syndrome
Por:
Lugo VM, Torres M, Garmendia O, Suarez-Giron M, Ruiz C, Carmona C, Chiner E, Tarraubella N, Dalmases M, Pedro AM, Egea CJ, Abellana M, Mayos M, Monasterio C, Masa JF, Farré R and Montserrat JM
Publicada:
1 ene 2020
Ahead of Print:
5 abr 2019
Categoría:
Pulmonary and respiratory medicine
Resumen:
Background: Large variation in diagnostic procedures and treatment recommendations may hinder the management of obstructive sleep apnea (OSA) and also compromise correct interpretation of the results of multicenter clinical trials, especially in subjects with non-severe OSA. The aim of this study was to analyze the therapeutic decision-making between different sleep physicians in patients with AHI<40 events/h.
Methods: Six experienced senior sleep specialists from different sleep centers of Spain were asked to make a therapeutic decision ( CPAP treatment) based on anonymized recordings of patients with suspected OSA that has previously performed a sleep study. The clinical data was shown in an online database and included anthropometric features, clinical questionnaires, comorbidities, physical examination and sleep study results. Intra- and inter-observer decision-making were analyzed by the Fleiss' Kappa statistics (Kappa).
Results: A total of 720 medical decisions were taken to analyze the agreement between sleep professionals. Overall intra-observer evaluation reliability was almost perfect (Kappa = 0.83, 95% CI, 0.75-0.90, p< 0.001). However, overall inter-observer concordance decreased to moderate agreement (Kappa = 0.46, 95% CI, 0.42-0.51, p< 0.001). Nevertheless, it was especially low when considering AHI < 15 events/h.
Conclusions: This study demonstrates a good intra-observer concordance in the therapeutic decision-making of different sleep physicians treating patients with low/moderate OSA. However, when analyzing inter-observer agreement the results were considerably worse. These findings underline the importance of developing improved consensus management protocols. (C) 2019 Published by Elsevier Espana, S.L.U. on behalf of SEPAR.
Filiaciones:
Lugo VM:
Sleep Unit, Hospital Clínic, Barcelona, Spain
Torres M:
Sleep Unit, Hospital Clínic, Barcelona, Spain
IDIBAPS, Barcelona, Spain
CIBER Enfermedades Respiratorias, Madrid, Spain
Garmendia O:
Sleep Unit, Hospital Clínic, Barcelona, Spain
IDIBAPS, Barcelona, Spain
CIBER Enfermedades Respiratorias, Madrid, Spain
Suarez-Giron M:
Sleep Unit, Hospital Clínic, Barcelona, Spain
Ruiz C:
Sleep Unit, Hospital Clínic, Barcelona, Spain
Carmona C:
Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocío University Hospital, Sevilla, Spain
:
Unidad multidisciplinar de Sueño, Servicio de Neumología, H.U. Sant Joan d'Alacant, Alacant, Spain
Tarraubella N:
Atenció Primària Àmbit Lleida, Lleida, Spain
Dalmases M:
CIBER Enfermedades Respiratorias, Madrid, Spain
Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Spain
Pedro AM:
ABS Gaudí, CAP Sagrada Família, Consorci Sanitari Integrat (CSI), Barcelona, Spain
Egea CJ:
CIBER Enfermedades Respiratorias, Madrid, Spain
Sleep Disorders Unit, Hospital Txagorritxu, Vitoria, Spain
Abellana M:
CAP Guissona, Àrea Cervera, Lleida, Spain
Mayos M:
CIBER Enfermedades Respiratorias, Madrid, Spain
Sleep Unit, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Monasterio C:
CIBER Enfermedades Respiratorias, Madrid, Spain
Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
IDIBELL, L'Hospitalet de Llobregat, Spain
Masa JF:
Respiratory Unit, Hospital San Pedro de Alcántara, Cáceres, Spain
Farré R:
CIBER Enfermedades Respiratorias, Madrid, Spain
Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
Montserrat JM:
Sleep Unit, Hospital Clínic, Barcelona, Spain
IDIBAPS, Barcelona, Spain
CIBER Enfermedades Respiratorias, Madrid, Spain
Universitat de Barcelona, Barcelona, Spain
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