Study objectives: To study the effect of American Academy of Sleep Medicine accreditation of sleep centers and sleep-medicine certification of physicians on the management of patients with obstructive sleep apnea (OSA).
Design: Cross-sectional study.
Setting: National web-based survey.
Patients: Six hundred thirty-two patients with OSA.
Measurements and results: Self-reported data on details of whether patients with OSA were using positive airway pressure (PAP) devices, timeliness of the initiation of PAP therapy, and overall satisfaction of care received from physicians and centers. After adjusting for covariates, lack of accreditation or certification status of providers was independently associated with discontinuation of PAP therapy (odds ratio [OR] 1.9, 95% confidence interval [CI], 1.1-3.2; p = .03). Patient education leading to perception of risk associated with OSA (OR 0.5, 95% CI, 0.2-0.9) and medications for nasal congestion (OR 0.3, 95% CI, 0.1-0.8) "protected" against discontinuation of PAP therapy, whereas nasal congestion (OR 1.6, 95% Cl, 1.0-2.4) increased the likelihood for discontinuation of PAP therapy. Certified physicians and accredited centers were more likely to educate their patients and received greater satisfaction ratings than non-certified physicians and nonaccredited centers (p < .05). Time delays in instituting PAP therapy were not influenced by accreditation or certification status, but such delays diminished patient satisfaction.
Conclusions: In this web-based survey, accreditation or certification status of sleep centers and physicians was associated with better indexes of clinical management in patients with OSA. Better patient education that fostered risk perception may have been partly responsible for such an association. Prospective studies designed to collect objective data regarding the effect of accreditation or certification status on outcomes in patients with OSA are still needed.