Physician self-reported knowledge of and barriers to indication of alternative therapies for treatment of obstructive sleep apnea

Abstract

Abstract Background Obstructive sleep apnea (OSA) is a common disease with significant implications for individual physical and mental wellbeing. Though in theory, OSA can be effectively treated with positive airway pressure therapy (PAP), many patients cannot adhere chronically and require alternative treatment. With sleep physicians being relevant stakeholders in the process of allocation of OSA treatments, this research aims to study their knowledge and perceptions of alternative therapies available in routine care in Germany. Methods This work is part of a larger research project which aims to assess the state of sleep medical care in Germany. Items relevant to this study included self-reported knowledge, indication volumes, and perceptions of five alternative treatments for OSA, which are available for routine care in Germany. Results A total of 435 sleep physicians from multiple medical disciplines and both care sectors participated in the study. Self-reported knowledge on alternative OSA treatments was moderate and correlated with the consultation volume. Self-reported adoption of alternative therapies was higher in nonsurgical methods, and only 1.1% of participants reported not utilizing any of the alternative treatments. The most relevant perceived barriers to indication were “reimbursement issues” for mandibular advancement devices and positional therapy; “evidence insufficient” for upper airway surgery, and “no demand from patients” for hypoglossal nerve stimulation and maxillomandibular Advancement. Conclusion Self-reported knowledge of alternative OSA treatments is moderate and indication of alternative OSA therapies varies substantially. Sleep physicians often perceive barriers that limit provision or referrals for provision of these treatments. Additional research is required to further understand barriers and factors influencing creation of those perceptions and decision-making among physicians.