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Implementing NICE guidance

Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Implementing NICE guidance. 2008. NICE technology appraisal guidance 139. What this presentation covers. Definitions Recommendations Clinical need Costs and savings DH Funding waiver

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Implementing NICE guidance

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  1. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome Implementing NICE guidance 2008 NICE technology appraisal guidance 139

  2. What this presentation covers • Definitions • Recommendations • Clinical need • Costs and savings • DH Funding waiver • Discussion • Implementation

  3. Definitions • Apnoea – a temporary absence or cessation of breathing • OSAHS – a condition in which a person experiences repeated episodes of apnoea because of a narrowing or closure of the pharyngeal airway during sleep, resulting in daytime symptoms, especially excessive sleepiness • CPAP – continuous positive airway pressure

  4. Recommendation:moderate or severe OSAHS • CPAP is recommended as a treatment option for adults with moderate or severe symptomatic OSAHS.

  5. Recommendation:mild OSAHS • CPAP is only recommended as a treatment option for adults with mild OSAHS if: • they have symptoms that affect their quality of life and ability to go about their daily activities, and • lifestyle advice and any other relevant treatment options have been unsuccessful or are considered inappropriate.

  6. Recommendation:diagnosis and treatment • The diagnosis and treatment of OSAHS, and the monitoring of the response, should be carried out by a specialist service with appropriately trained medical and support staff.

  7. OSAHS symptoms and associated problems • Excessive daytime sleepiness • Impaired alertness • Cognitive impairment • Snoring • Other possible symptoms • Impact on partners and quality of life • Association with cardiovascular disease and road traffic accidents

  8. Risk factors for OSAHS • Increasing age • Gender • Obesity • Specific craniofacial characteristics • Enlarged tonsils or tongue

  9. Treatment of OSAHS • Treatment aims • Lifestyle management, including weight loss • Dental devices • Surgery

  10. CPAP technology • Types of CPAP: • fixed • auto-titrating • Non-adherence to treatment

  11. Costs per 100,000 population

  12. Possible barriers to treatment • Low recognition of the problem • Inadequate access to services • Intolerance of CPAP treatment

  13. For discussion • Which recommendations will require a change in practice for you? • Are there existing practices that are no longer recommended, allowing transfer of resources? • What is the current level of service provision? – consider both the short- and long-term needs of patients • How do we do effectively support patients? • What additional training is needed for primary care?

  14. Access tools online • Costing tools: • costing report • costing template • Implementation advice • Audit support • Available from: www.nice.org.uk/TA139

  15. Access the appraisal online • Quick reference guide – a summary www.nice.org.uk/TA139quickrefguide • Full guidance – all of the evidence and rationale www.nice.org.uk/TA139guidance • ‘Understanding NICE guidance’ – a plain English version www.nice.org.uk/TA139publicinfo

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