Primary care providers may be ideally positioned to have a larger role in treating obstructive sleep apnea. Objectives: Using an individual-participant data meta-analysis, establish whether age, gender, the severity of OSA, and daytime sleepiness impacted outcomes and cost-effectiveness of sleep apnea management in primary versus specialized care. CINAHL, CENTRAL, MEDLINE Ovid SP, Scopus, ProQuest, US NIH Ongoing Trials Register, and ISRCTN registry [inception through 09-25-2019] were used as data sources. Hand-searching was carried out. At baseline and follow-up, two authors independently assessed articles and included trials that randomized adults with a suspected diagnosis of sleep apnea to primary versus specialist management within the same study and reported daytime sleepiness using the Epworth Sleepiness Scale (range 0-24; >10 indicates pathological sleepiness; minimum clinically important difference two units).
The primary analysis included data from all 970 individuals (100%) in a study (four trials). The possibility of prejudice was determined (Cochrane Tool). In primary care, a one-stage intention-to-treat analysis revealed a slightly lower reduction in daytime drowsiness (0.8; 0.2 to 1.4) but a significantly higher diastolic blood pressure (-1.9; -3.2 to -0.6 mmHg), with comparable findings in the per-protocol analysis. The expenses of a primary care-based within-trial healthcare system were lower (-$448.51), and quality-adjusted life-years and improvements in daytime sleepiness were less expensive. In both management scenarios, they obtained similar primary outcome results for subgroups. Similar outcomes at a lower cost in general care give significant justification for implementing primary care-based sleep apnea management.