Response from Chai-Coetzer CL, Antic N and McEvoy D to Commentary by Collop N: Primary vs. Specialist Care in management of Sleep Apnea

The science of the study was extensively canvassed during journal review and we do not think it particularly helpful to re-visit Dr. Collop's criticisms concerning the statistical approach used, change in ESS as the primary endpoint etc. However, we do think it important to comment on the broader translational issues that she has raised. Dr. Collop wholeheartedly agrees that “primary care physicians should take a more active role in diagnosing, and even managing OSA” but then lists a series of perceived barriers. These include that PCPs and their nurses are already too busy and OSA diagnosis and management is too complex for them to be concerned with sleep apnea, that they lack the necessary education and that reimbursement models are not aligned with primary care management. She argues for maintenance of the status quo whereby sleep medicine specialists remain the sole providers of OSA diagnosis and management.