osa next steps report

OSA Next StepsWhy obstructive sleep apnoea must be a health priority

Executive summary 03

‘Without breath’ – what is obstructive 04 sleep apnoea(OSA)?

OSA in the new health landscape 06

Awakening – why OSA must be a health priority 07

Treatment is easy and cost-effective 08

OSA can contribute to better 09 overall health outcomes

Improving outcomes and care for 10 people with OSA – a call to action

Summary of OSA-related indicators 14 in the outcomes frame works

Contents

Foreword

The NHS in England will see significant change over the coming year. New

bodies, boards, posts and ways of working will all need to be considered as

we strive to continue our work to raise awareness of obstructive sleep apnoea

(OSA), to improve the lives of people with OSA, to standardise service

provision and to ensure that OSA remains a priority in the reformed NHS.

This report focuses on priorities for the NHS in England, following these recent changes.

However, many of the issues raised apply across the UK, and the British Lung Foundation’s

OSA campaign includes activity in all four UK nations.

We know that OSA can severely impair quality of life. Untreated OSA can cause hypertension and

it is also independently associated with type 2 diabetes and cardio-vascular disease. Improving

screening, referral, diagnosis, treatment and management of OSA will have positive effects on

OSA patients and help to improve their quality of life. Effective treatment has been shown to

ameliorate hypertension and reduce the risk of cardio-vascular disease. There has been excellent

collaboration to date between sleep experts, patients, charities, politicians, industry and the

Department of Health to ensure progress is made on identifying actions needed to improve the

lives of people with OSA. This collaboration was demonstrated in the work of the OSA working

group, convened by the Department of Health. The task now is to ensure that the momentum and

impetus for making these identified improvements are continued as the new NHS takes shape.

There is a crucial need for local authorities, Public Health England, NHS England, clinical

commissioning groups, health and wellbeing boards, Healthwatch, patient groups and the

Department of Health to work together to ensure that progress continues to be made to improve

OSA care and services. I hope that this report will go some way towards setting out some of the key

actions needed, and identifying the key people who are best placed to carry these out, to ensure

continued progress is made for OSA patients. The BLF looks forward to being a part of that progress.

Dr Penny Woods

Chief Executive, British Lung Foundation

3OSA Next Steps 2013 | www.blf.org.uk/osa

Executive summary

OSA is a major health challenge in the UK, affecting up to 2 per cent of middle-aged women and up to 4 per cent of middle-aged men.

From 1 April 2013, responsibility for improving healthcare and support for people with OSA and their families in England spans across the newly created agencies in the new NHS and public health landscape: NHS England, clinical commissioning groups, Public Health England and local authorities.

Prioritising OSA in this new health landscape will directly support the NHS and local government in England in achieving a number of nationally set outcomes and goals. In addition, a number of key opportunities for incentivising OSA care and support exist within the current framework, levers and mechanisms.

The BLF’s Next Steps report outlines five key areas where action is needed to ensure that OSA is a national and local priority. These five areas are:

building the evidence base around OSA;

building an accurate picture of current sleep service levels;

supporting screening for signs and symptoms;

producing a national standard on diagnosis and treatment of OSA; and

providing information and ongoing support for OSA patients.

1

2

3

4

5

4 OSA Next Steps 2013 | www.blf.org.uk/osa

what is obstructive sleep apnoea?

“I told my GP I felt weak and depressed. It took five years

to be referred to a sleep clinic.”

Apnoea is a Greek word meaning ‘without breath’. Obstructive sleep apnoea is a condition where a person stops breathing temporarily during their sleep, sometimes several hundred times a night, due to their throat collapsing and becoming blocked. The brain needs to arouse from sleep to start the person breathing again, and this causes a partial awakening, which the person may or may not be aware of. This disruption to sleep can lead to a person feeling very sleepy during the day, and is linked with other serious health consequences.

‘Without breath’

“My GP said I wouldn’t qualify for treatment as I was overweight.”

PAtIENt vOICES

“I was wrongly diagnosed with asthma by my GP.”


and impact of OSA

OSA CAN CAUSE HyPErTENSION AND UNTrEATED OSA IS ASSOCIATED WITH HEArT DISEASE, STrOKE,TyPE 2 DIABETES AND OBESITy

the burden

UP TO 4 PEr CENT OF mIDDLE-AGED mEN AND 2 PEr CENT OF mIDDLE-AGED WOmEN IN THE UK HAvE OSA

OLDEr PEOPLE ArE EvEN mOrE AT rISK, WITH 15 TO 20 PEr CENT OF THOSE AGED 70 AND OvEr ESTImATED TO HAvE THE CONDITION

PEOPLE WITH OSA mAy HAvE A LIFE ExPECTANCy OF 20 yEArS LESS THAN THE GENErAL PUBLIC People with undiagnosed OSA have a

higher risk of road traffic accidents and accidents at work. Studies suggest that driver tiredness may be a contributory factor in as many as 20 per cent of all road accidents

THE qUALITy OF LIFE FOr THE PErSON AND THEIr FAmILy CAN BE SEvErELy ImPAIrED

1/4MILLION

It is thought that 1 per cent of men in the UK – more than a quarter of a million people – have severe OSA

Undiagnosed OSA is expensive to the health care system; expenditure on undiagnosed patients is estimated to be twice the amount spent on members of the general public who are the same age and gender

Up to 80 per cent of people with OSA have not yet been diagnosed, and some studies suggest this could be even higher


At a local level, clinical commissioning groups (CCGs), held to account by NHS England, will take on primary responsibility for diagnosing OSA and providing treatment through the commissioning of sleep services. These services will be funded by the £63 million CCG budget.

Planning and oversight in the new health and social care system will come through the new outcomes frameworks:

• NHS Outcomes Frameworki

• Public Health Outcomes Frameworkii

• Adult Social Care Outcomes Frameworkiii

• CCG Outcomes Indicator Setiv

Public health interventions to tackle the risk factors for OSA, such as obesity, will become the responsibility of local government. Nationally, Public Health England will provide public health surveillance and support for local authorities in delivering interventions to meet their Public Health Outcomes Framework indicators relating to OSA on obesity and diet.

Prevention of OSA will also be promoted through the NHS Health Check, which is offered to

everyone aged 40-77 to assess their risk of heart disease, stroke, type 2 diabetes and kidney disease and provide tailored advice to address these risks. While OSA is not included in the Health Check, the aim of reducing risks of key co-morbidities, such as obesity and high blood pressure, will be important in tackling the risk factors associated with OSA.

The overall strategic direction and monitoring of local OSA commissioning and service delivery will take place through health and wellbeing boards in each upper-tier local authority. representatives from CCGs and local authorities have a statutory duty to sit on these boards.

Local prioritisation of OSA will be based on the extent to which local authorities and CCGs consider the condition within their assessments of current and future local health needs. These decisions are contained in a document called a Joint Strategic Needs Assessment (JSNA). Using these JSNAs, the local authorities and CCGs will then devise joint strategies to be agreed by the health and wellbeing board and used as the basis for local delivery of NHS and public health services.

“Life was a bit of a dream.”

“I felt desperate.”

OSA in the new health landscape

NHS England will take on a key strategic role in ensuring that the range of NHS outcomes indicators associated with OSA are met nationally, led by the relevant clinical domain leads and the national clinical director for respiratory disease.

PAtIENt vOICES

“I was exhausted.”


OSA is a significant and growing health concernOSA is a common condition. Up to 4 per cent of middle-aged men and 2 per cent of middle-aged women in the UK have OSA with symptoms.v However, estimates vary, and these estimates are from the 1990s; actual figures may be higher due to the increased prevalence of obesity. It is also thought that 1 per cent of men in the UK – more than a quarter of a million people - have severe OSA.vi

Older people are even more at risk, with 15 to 20 per cent of those aged 70 and over estimated to have the condition.vii This means that OSA is more common than severe asthma.viii

OSA also affects up to 3 per cent of children, most of whom have large tonsils, and is more common among children with certain disabilities, such as Down’s syndrome, and in very obese children.x

OSA can have a significant impact upon those it affects, not just for patients, but also for their family and colleagues. The condition can lead to a range of serious health complications and negatively affect a person’s sense of health and wellbeing,

as well as having an impact on their social and professional life.

It is thought that up to 80 per cent of people with OSA have not yet been diagnosed, with some studies suggesting this could be even higher.xi Undiagnosed OSA is also a costly burden for the NHS and wider society in general. Expenditure on undiagnosed patients is estimated to be around twice that of members of the public who are the same age and gender.xii

Cardiovascular riskThere is strong evidence that OSA is a significant risk factor for cardiovascular disease and mortality. research has shown that people with OSA have higher blood pressure and untreated OSA is associated with a risk of arrhythmias, stroke and coronary heart disease.

Death rates from cardiovascular disease are high in people with OSA, with the rate increasing with the severity of the OSA. In one large study, cardiovascular disease accounted for 42 per cent of deaths in people with OSA, compared to 26 per cent of people without the condition.xiii men with severe OSA

have a 58 per cent higher risk of incident heart failure than men without OSA.xiv

OSA prevalence is higher among patients with cardiovascular conditions. Between 30 per cent and 57 per cent of patients with coronary artery disease have also been found to have OSA.xv

Evidence also suggests a relationship between OSA, obesity and diabetes, with 50 per cent of type 2 diabetes patients having OSA. This number rises to 86 per cent of obese type 2 diabetes patients. Furthermore, OSA is an independent risk factor for diabetes, as it is associated with increasing glucose metabolism which places patients at increased risk of development of type 2 diabetes.xvi

Links with obesity People who are very overweight are more at risk of developing OSA than people who are not overweight. Estimates vary, but around half of people with OSA have excess body weight, which, it has been suggested, can affect breathing in different ways.xvii rising obesity levels in the UK are set to make OSA an even greater future public health challenge.

why OSA must be a health priority

Awakening“I was semi-comatose, in a fog.”

“I fell asleep driving.”

“I had to stop work.”

PAtIENt vOICES


treatment is easy and cost-effective

Treatments for OSA aim to alleviate daytime sleepiness by reducing the number of apnoeas (complete cessation of breathing) and hypopnoeas (restricted breathing). OSA is easy to treat, and treatment is cost-effective, as confirmed by the National Institute of Health and Clinical Excellence (NICE).

The NICE-recommended treatment for moderate to severe symptomatic OSA is CPAP (continuous positive airway pressure) – a simple machine which pumps air through a mask at night. Other treatment options are also available, particularly for obese patients (where weight loss surgery can help) and those with milder OSA (where an intra-oral device may be more suitable, designed to keep the upper airway open during sleep by holding the lower jaw forwards). A sleep specialist will decide on the best option following discussion with the patient.

Treatment is also clinically effective at addressing key cardiovascular risks. Evidence shows that treatment with CPAP reduces blood pressure, which may decrease cardiac risk by 20 per cent and stroke risk by 40 per cent over a five to 10-year period.xviii

Kath describes how CPAP treatment has made a difference to her life.

“I was confident my sleep test would prove I didn’t have OSA. But it turned out I had moderate to severe OSA, averaging 30 apnoeas per hour.

“yes, I knew I was a snorer and, yes, I was always tired and exhausted. But I put that down to being a busy music teacher and just allowed myself the odd nap when I could fit one in. I certainly wasn’t overweight.

“my diagnosis was a relief. It explained why I would practically collapse with exhaustion every now and then. And I’d lost count of the times I’d been checked for anaemia, glandular fever, leukaemia, diabetes, etc. If I’d been diagnosed with sleep apnoea years ago, it would have saved the NHS a lot of money. most importantly, I was told I could enjoy a much better quality of life with CPAP treatment.

“I was excited the day I brought my CPAP machine home. I’d heard stories of overnight cures. Well that didn’t happen. The truth is that most people have to persevere to get the comfortable night’s sleep we deserve.

“I was determined to make it work, however. Today, I feel healthier than I did in the 20 years before my diagnosis, and now have the energy to run two businesses. I’m pleased to say that CPAP has come to be my best friend.”

CPAP is my best friend!


The NHS Outcomes Framework includes outcomes indicators on:

• Domain 1: reducing premature mortality from cardiovascular disease (1.1) and respiratory disease (1.2)

• Domain 2: Improved health-related quality of life for people with long-term conditions, including the ‘proportion of people feeling supported to manage their condition’ (2.1) and ‘employment of people with long-term conditions’ (2.2)

As a condition which can increase risk of cardiovascular disease and mortality, improvements in OSA care and treatment will help commissioners achieve cardiovascular outcomes, in particular NHS Outcome Indicator 1.1 (see above).

Given that OSA is a respiratory condition which, if untreated, can lead to a reduced life expectancy of 20 years, NHS Outcome Indicator 1.2 also remains relevant to OSA care and treatment.

As a long-term condition, OSA also relates to Domain 2 of the NHS Outcomes Framework. Appropriate

treatment, care and support for people with OSA will enhance outcomes in terms of quality of life, people feeling supported in managing their condition, and in maintaining employment.

Outcomes indicators on respiratory and cardiovascular mortality are also included in the Public Health Outcomes Framework.

The Public Health Outcomes Framework includes in Domain 1 (improving the wider determinants of health), an outcome indicator on:

• Killed or seriously injured casualties on England’s roads (1.10)

People with undiagnosed OSA have a higher risk of road traffic accidents and accidents at work. Studies suggest that driver tiredness may be a contributory factor in as many as 20 per cent of all road accidents.xix

There are relevant indicators in the Public Health Outcomes Indicators relating to diet, excess weight and take up of the Health Check (PHOF 2.11, 2.12, 2.22) which will address obesity levels in the UK. meeting these objectives could play an important role in preventing OSA.

OSA is also linked to a number of other outcomes indicators in the NHS and Public Health Outcomes Framework, and the CCG Outcomes Indicator Set. Please see the outcomes indicators summary on page 14.

“I thought ‘Oh my god, I’ll be normal now’.”

“the feeling in the morning after a good night’s sleep was

totally overwhelming.”

OSA can contribute to better overall health outcomes

The new health landscape is underpinned by outcomes frameworks at national and local levels, as described above. The outcomes frameworks do not include a specific outcomes indicator on OSA. However, tackling OSA will help to bring about improvements to overall health outcomes, as the condition has a significant impact on a number of outcomes indicators.

“treating someone with OSA is so rewarding – it’s a life-changer.”

“treatment saves lives. I call it my happy clinic.”

“My CPAP is like a comfort blanket.”

“the next day I woke up feeling like a million dollars.”

CLINICIANS’ vIEWS

PAtIENt vOICES


Build the evidence base on OSA

Improving outcomes and care for people with OSA – a call to action

OSA is a serious health condition that has a detrimental impact on overall health outcomes, particularly in relation to cardiovascular and respiratory health, and a broader impact on individuals as a long-term condition.

Ensuring people with OSA are identified and provided with appropriate treatment can improve overall health outcomes and quality of life.

This section outlines how outcomes and care for people with OSA can be improved along the patient pathway through effective screening, referral and commissioning of diagnostic, treatment and management services.

A key challenge for OSA is the lack of data on prevalence and the cost benefit of preventing and treating the condition, versus not treating it.

At both a national and local level, little data is available on the prevalence of OSA. This makes it difficult for commissioners in clinical commissioning groups to effectively commission services, such as specialist sleep services, for people with OSA. Action is needed to provide the evidence base to understand the scale of the challenge of OSA at a national and local level, and to deliver services that meet those needs.

In addition, while much research has focused on the efficacy of treatment, especially CPAP, there has been little research or reporting to date on assessing the direct systemic cost savings

to health services as a result of successful treatment, or on the wider economic impact of successful and/or early treatment versus no treatment for people with OSA. research that has been conducted on this area has been mainly outside the UK.

A programme of research activities focusing on OSA health economics is needed. This should involve summarising the known research findings relating to OSA and health economics along the patient pathway, and calculating from known findings the estimated costs to society of OSA in the UK.

It is vital to understand the cost impact of OSA to the health service and wider society, in order to support efforts to help improve access to OSA services.

1 Calls to action:

National

• NHSEnglandshouldfundamajorhealtheconomicstudyonOSAthatincludesprevalencemodellingand acostbenefitanalysis.

Local

• LocalauthoritiesshouldincludeanassessmentofOSAintheirJointStrategicNeedsAssessments.WheredataonOSAisunavailable,localauthoritiesshouldworkwithnationalandregionalbodiestoestimateprevalence.

• Commissionersshouldwork withcliniciansandpatients tounderstandthelocalneeds ofpatientswithOSA.


In 2012/13, the BLF worked with Lovell Johns, a specialist mapping agency, to record existing data on sleep services in the UK. The data was obtained from seven different sources – mainly organisations working in sleep medicine that have lists of known sleep clinics. The results of this work outlined significant gaps in data at a national level on sleep services across the UK. For example, there is no agreed definition of what a sleep clinic is, so it is very difficult to collate information about these services. Furthermore, sleep clinics range from a simple sleep

study and diagnostic service for OSA as part of a respiratory clinic, to a ‘full’ sleep service offering a whole range of diagnostic and treatment options for a range of sleep disorders, including OSA. Sleep services have developed organically as a result of local enthusiasm and knowledge, rather than at a strategic level, looking at population needs. There are some exceptions; in some regions, for example, a model has been developed where the roles of primary care, secondary care and tertiary are clearly defined.

While awareness of OSA has improved over the last few decades, there are still many people with undiagnosed OSA.

One key factor in this low diagnosis rate is the low awareness and recognition of the condition by health care professionals, in particular those working in primary care.

more is needed to ensure that GPs are better able to recognise OSA symptoms and understand the causes and risks of the condition.

Build an accurate picture of current sleep service levels

Support screening for signs and symptoms

2

Calls to action:

National

• NICEshouldexploretheopportunityforthedevelopmentofQualityofOutcomesFrameworkindicatorsandincludeapertinentindicatorforOSAscreening,suchasensuringthatthosewithaBMIof35oraboveandthosewithtype2diabetesarescreened,orthatanOSAscreeningquestionisaddedtorelevanthealthchecks.

• NHSEnglandshouldworkwithNHSImproving QualitytodevelopanationalOSAprimarycareawarenessactionplan.

Local

• CCGsshouldensurethatlocally-agreedhealth andwellbeingstrategiesprioritiseOSAscreening.

• CCGsshouldprioritiseandpromoteawarenessofOSAamonghealthcareprofessionalsacrossprimarycare,includingGPs,nursesandpharmacists,throughtheimplementationofanationallyagreedOSAprimarycareawarenessactionplan.

3

Calls to action:

National

• NHSEnglandshouldcommission anationalauditofsleepservicesintheUK.

Local

• HealthandwellbeingboardsshouldauditlocalservicesforOSA.

Case study: Huntingdon’s simple screening system

In Huntingdon, an OSA screening service has been

set up by the local CCG, and is provided by GP

surgeries. Patients only need to travel to their GP

surgery to pick up the equipment for their overnight

sleep study. The results of the study, along with a

clinical history and screening results, are then sent

to Papworth Hospital by the GP practice for analysis.

This system is being rolled out in the local area.


Produce a national standard on diagnosis and treatment for OSA

research carried out by the BLF has shown that there is wide variation between the assessment and diagnostic facilities available, and protocols used across different settings. There is also wide variation in timescales of assessment and treatment, with time between assessment (sleep study) and treatment ranging from one day to several weeks.

There is not currently a NICE quality standard or NICE guideline on OSA, although a quality standard for sleep-disordered breathing, of which OSA will be a major component, has been referred to NICE for development.

4

Calls to action:

National

•NICEtodevelopthequalitystandardonsleep-disorderedbreathing.

•NICEtodevelopdetailed guidelinesondiagnosis,assessment,referralandtreatmentforOSA.Theguidelinesshouldalsolookatsleepservicesforchildren,patientswithco-morbidities,lifestyleadviceandhospital-basedspecialistsleepservices.

•SleepservicesshouldreceiveanaccreditationbyanationalbodysuchastheAssociationforRespiratoryTechnologyandPhysiologyortheBritishSleepSocietytofacilitatethesharingofbestknowledgeandpracticeandensurecontinuousimprovement insleepdiagnosticsandservices.

•NHSEnglandshouldcontinuetheworkoftheDepartmentofHealth’sOSAworkinggrouptoreviseaservicespecificationforOSA,andshoulddisseminatethistosleepclinicsasbestpracticeforserviceprovision.

•Guidelinesshouldbeupdatedonaregularbasistoreflectnewresearchfindingsandclinicalpractice.

The development of this standard represents an important opportunity to prioritise OSA within the NHS Outcomes Framework. As a long-term condition, OSA relates directly to the aims in Domain 2 of the NHS Outcomes Framework, which are based around ‘enhancing quality of life for people with long-term conditions’.

Diagnosis of OSA normally involves a subjective sleepiness test (the Epworth sleepiness scale is the most widely used) and an objective test, either using a simple overnight sleep study (where a patient wears a small device during sleep to measure oxygen levels in the blood and heart rate), or a more detailed sleep study.

Case studies: setting standards across the UKIn the north west of England, the North West regional Sleep Network was developed, which established a four-level sleep model for treatment and diagnosis, involving primary care, secondary care and specialist hospital services. The model also includes a local service specification and training recommendations for sleep staff at all levels.

In Scotland, the Scottish Sleep Forum has developed a minimum standards document for sleep services, based on the Scottish Intercollegiate Guidelines Network (SIGN) guidelines.

In Oxford, a ‘one stop shop’ service has been developed, where patients pick up their equipment for their sleep study one day, then return with it the next day, when the results are downloaded and analysed. On that same day, patients are assessed, diagnosed, set up on their new treatment and sent home with it.


CPAP treatment is just that – a treatment and not a cure. Patients must therefore understand how to use their treatment and manage their condition, otherwise symptoms will return. Providing appropriate information and ongoing support to OSA patients is vital. This information and advice should adhere to an agreed national standard and should be provided by qualified and trained staff.

Calls to action:

Local

• CCGsshouldensurethat:peoplewithOSAhaveaccesstoclearandaccurateinformationabouttheircondition,includingappropriateCPAPtraining;allpatientsareofferedaneducationprogrammetomakesuretheycanuseandcarefortheirequipmentproperly;andCPAPadherence/complianceismonitoredandaddressedifnotoptimal.

• LocalHealthwatchorganisationsshouldpromotetheprovisionofadviceandinformationtopatientsreceivingOSAcareandservices,includingadviceonwhatsupporttheyareentitledto.

Provide information and on-going support5Case study: keeping in touch at Guy’s and St thomas’At Guy’s and St Thomas’ Hospital in London and york Hospital in yorkshire patients receive an annual review once they have been diagnosed with OSA. This can include a check-up of their equipment, to ensure it is in good working order and see if any elements need replacing, a review of their compliance with treatment, and a review of their health and any symptoms which may indicate that a change in treatment is required.

Local

•CCGstoimplementqualitystandardonsleep-disorderedbreathingwhenpublished.

•CCGsshouldensurealternativetreatmentoptionsareofferedtopatientswhocannotcomplywithCPAPorwhoaremildlyaffected,suchascustom-madeintra-oraldevices.ThereisaNationalInstituteforHealthResearchstudyonhowtousethesedevicescurrently,whichmayprovideguidance.CCGsshouldalsoconductanauditoftheCCGcarepathway,reviewingreferralproceduresandaccesstosleepservices.

•CCGsshouldensurefundingtoimplementNICETechnologyAppraisalGuidance139inrespectof:providingfundingforcontinuouspositiveairwaypressure(CPAP)therapy–includinghumidificationwhereneeded-forallpatientsdiagnosedwithmoderatetoseveresymptomaticOSA;andconsideringtheuseofCPAPforpatientswithmilderOSAwhoareseverelysymptomatic.AlternativetreatmentoptionsshouldbeofferedtopatientswhocannotcomplywithCPAPorwhoaremildlyaffected,suchasintra-oraldevicesandaccesstoweightlossservices,providedwithin arecognisedservice.


Summary of OSA-related indicators in the outcomes frameworks

Below is a summary of the indicators related to OSA in the current outcomes frameworks for the NHS and public health. There is also a list of outcomes indicators that link to factors that can prevent OSA.

Achieving the following outcomes indicators will help improve care and services for people with OSA:

Outcomes Framework Indicator

NHS Outcomes Framework – Domain 1: Preventing people from dying prematurely

1.1

1.2

reducing premature mortality from cardiovascular disease

reducing premature mortality from respiratory disease

NHS Outcomes Framework – Domain 2: Enhancing quality of life for people with long-term conditions

2.1

2.2

Proportion of people feeling supported to manage their condition

Employment of people with long-term conditions

Public Health Outcomes Framework – Domain 1: Improving the wider determinants of health

1.10 Killed or seriously injured casualties on England’s roads

Public Health Outcomes Framework – Domain 4: Healthcare public health and preventing premature mortality

4.3 4.4

4.7

mortality from causes considered preventable

mortality from cardiovascular diseases (including heart disease and stroke)

mortality from respiratory diseases

CCG Outcomes Indicator Set – Domain 1: Preventing people from dying prematurely

C1.1

C1.2

C1.6

Combined indicator on potential years of life lost (PyLL) from causes considered amenable to healthcare adults and children and young people

Under 75 mortality from cardiovascular disease

Under 75 mortality from respiratory disease

CCG Outcomes Indicator Set – Domain 2: Enhancing quality of life for people with long-term conditions

C2.1

C2.2

Health-related quality of life for people with long-term conditions

People feeling supported to manage their condition

CCG Outcomes Indicator Set – Domain 4: Ensuring that people have a positive experience of care

C4.4 Patient experience of outpatients services

Improvements in the following outcomes indicators may support OSA prevention:

Outcomes Framework Indicator

Public Health Outcomes Framework 0.1 Healthy life expectancy

Public Health Outcomes Framework – Domain 2: Health improvement

2.11

2.12

2.22

Diet

Excess weight in adults

Take up of the NHS Health Check

References

i Department of Health. 2012. NHS Outcomes Framework 2013/2014. [Online] Available at: http://www.dh.gov.uk/2012/11/nhs-outcomes-framework/ [Accessed 5 April 2013].

ii Department of Health. 2012. The Public Health Outcomes Framework 2013/2014. [Online] Available at: http://www.rcpsych.ac.uk/pdf/The%20Public%20Health%20Outcomes%20Framework.pdf [Accessed 5 April 2013].

iii Department of Health. 2012. The Adult Social Care Outcomes Framework 2013/2014. [Online] Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/141627/The-Adult-Social-Care-Outcomes-Framework-2013-14.pdf [Accessed 5 April 2013].

iv NHS. 2012. CCG Outcomes Indicator Set 2013/2014. [Online] Available at: http://www.england.nhs.uk/wp-content/uploads/2012/12/ois-fact.pdf [Accessed 5 April 2013].

v NICE. 2008. Continuous Positive Airway Pressure for the treatment of obstructive sleep apnoea/hyponea syndrome: Costing templates and report, p.4 [Online]. Available at: http://www.nice.org.uk/nicemedia/pdf/TA139guidance.pdf [Accessed 5 April 2013].

vi NICE. 2008. Continuous Positive Airway Pressure for the treatment of obstructive sleep apnoea/hyponea syndrome: Costing templates and report, p.4 [Online]. Available at: http://www.nice.org.uk/nicemedia/pdf/TA139guidance.pdf [Accessed 5 April 2013].

vii Department for Transport. 2011. Fatigue and road safety: a critical analysis of recent evidence (road safety web publication number 21), p. 11. [Online]. Available at: http://assets.dft.gov.uk/publications/fatigue-and-road-safety-a-critical-analysis-of-recent-evidence/rswp21report.pdf [Accessed 5 April 2013].

viii Shafazand S. 2009. Perioperative management of obstructive sleepapnea: ready for prime time? Cleveland Clinical Journal medicine 76 (Suppl 4), p.98-103.

ix American Academy of Otolaryngology, Head and Neck Surgery. 2007. Could my Child Have Obstructive Sleep Apnoea? [Online]. Available at: http://www.entnet.org/AboutUs/upload/KidsENT_Sleep-Apnea.pdf [Accessed 5 April 2013].

x Won Lee mD et al. 2008. Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective. Expert review of respiratory medicine. June 1; 2(3), pp. 349–364.

xi Won Lee mD et al. 2008. Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective. Expert review of respiratory medicine. June 1; 2(3), pp. 349–364.

xii Scottish Intercollegiate Guidelines Network, 2003. management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults, p. 14. [Online] Available at: http://www.sign.ac.uk/pdf/sign73.pdf [Accessed 5 April 2013].

xiii Fin young et al. 2008. Sleep Disordered Breathing and mortality: Eighteen-year Follow-up of the Wisconsin Sleep Cohor. Sleep; 31(8), pp. 1071-8

xiv Gottlieb et al. 2010. Prospective study of OSA and incident coronary heart disease and heart failure: The Sleep Heart Health Study. Circulation 122(4), pp. 352-60 [Online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20625114 [Accessed 10 April 2013].

xv Won Lee mD et al. 2008. Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective. Expert review of respiratory medicine. June 1; 2(3), pp. 349–364.

xvi Caples Sm, et al. 2005. Obstructive sleep apnea. Annals of Internal medicine 142 (3), pp.187–97

xvii Scottish Intercollegiate Guidelines Network, 2003. management of Obstructive Sleep Apnoea/Hypopnoea Syndrome in Adults, p. 7. [Online] Available at: http://www.sign.ac.uk/pdf/sign73.pdf [Accessed 5 April 2013].

xviii Pietzsch et al. 2011. An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate to severe OSA. Sleep; 34(6): pp. 695-709.

xix Jackson et al. 2011. Fatigue and road safety: a critical analysis of recent evidence (road safety web publication number 21). Department for Transport, p. 11. [Online]. Available at: http://assets.dft.gov.uk/publications/fatigue-and-road-safety-a-critical-analysis-of-recent-evidence/rswp21report.pdf [Accessed 5 April 2013]

Acknowledgements:Philips respironics, founding partnerresmed, partnerBLF OSA Advisory GroupSleep health care professionalsPeople with OSALovell Johnsmunro and Forster

Philips respironics is the founding partner of the British Lung Foundation obstructive sleep apnoea (OSA) programme, and resmed is a partner of the programme. Both companies provide funds to the programme but have had no influence over the contents of this report.

One person in five in the UK is affected

by lung disease. Millions more are at risk.

We are the UK’s lung charity and we are here for

every one of them, whatever their condition.

Lung disease can be frightening and debilitating.

We offer hope and support at every step so that no

one has to face it alone.

We promote greater understanding of lung disease

and we campaign for positive change in the

nation’s lung health.

We fund vital research, so that new treatments and

cures can help save lives.

We are the British Lung Foundation.

Leading the fight against lung disease.

registered charity in England and Wales (326730) and in Scotland (SC038415)

The British Lung Foundation has offices across the UK. Get in touch to find support near you.73-75 Goswell Road London EC1v 7ERHelpline: 03000 030 [email protected]

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