The Impact of Obstructive Sleep Apnoea (OSA) on Clinical Services and Cardiometabolic Diseases in Ireland

Obstructive sleep apnoea (OSA) is a growing global health concern, characterised by recurrent upper airway obstruction during sleep, disrupting ventilation and sleep patterns. Its prevalence is increasing due to aging populations and increasing obesity rates, yet a substantial portion of cases remain undiagnosed. OSA not only compromises quality of life but also independently contributes to cardiac and metabolic complications. While continuous positive airway pressure (CPAP) therapy effectively alleviated daytime sleepiness, its benefit with regard to cardiometabolic health remains uncertain. We firstly evaluated the impact of OSA on the incidence of cardiometabolic disease, cancer and mortality and potential impact of CPAP therapy over a 10-year median follow up of over 1,400 Irish participants within the European Sleep Apnoea Database (ESADA) serving as a reference population for Ireland. Subjects were interviewed using a structured questionnaire regarding mortality, new cardiac and metabolic events as well as CPAP usage. All responses were verified using medical records. Patients were grouped according to OSA severity and treatment status. The primary end point was the impact of OSA on mortality, with secondary endpoints evaluating the impact of the condition on cardiometabolic disease and cancer incidence, as well as the effect of CPAP therapy. The second portion of this study assessed a novel treatment pathway funded by the National Treatment Purchase Fund (NTPF) to address the lack of capacity within existing sleep services in Ireland to meet increasing patient demand. This pathway facilitated recruitment of additional medical personnel, as well as the use of Home Sleep Apnoea Testing (HSAT) and telemedicine. We hypothesised that waiting times for OSA patients to be diagnosed and treated would be reduced, and that the new pathway would prove to be a novel, cost effective diagnostic and management strategy with significant population health benefits. We prospectively compared 500 patients assessed via the new pathway compared to 500 subjects evaluated via the traditional, hospital-based model of care assessing parameters such as time to diagnosis and treatment initiation, CPAP adherence, economic costs and patient satisfaction with the novel pathway. Our study revealed that OSA severity was associated with an increased mortality risk as well as increased risk of cardiovascular events and diabetes in a symptomatic Irish population over a more than 10-year follow-up. There was some evidence that CPAP therapy may mitigate against the development of some of these effects. We found that the new clinical pathway significantly increased our capacity to screen symptomatic patients in a cost-effective, timely manner with significant patient satisfaction observed. Adherence to CPAP therapy was also non-inferior in the new pathway. Future areas of investigation include further studies evaluating the efficacy of CPAP therapy in the Irish population over a longer follow-up period, as well as implementation studies evaluating the efficacy of telemedicine on clinical outcomes and healthcare utilisation over the medium-longer term.