Severe obstructive sleep apnoea can be accurately diagnosed in primary care centres

We aimed to assess an obstructive sleep apnoea (OSA) diagnostic approach performed solely in primary care centres (PCC) with the support of an autoscoring home sleep apnoea testing (aHSAT, ApneaLink^TM Air) device and compare the diagnoses with those undertaken by the manual analysis of home sleep apnoea testing (mHSAT), and polysomnography (PSG) if necessary, of a certified sleep specialist. This multicentre, cross-sectional study was undertaken between April 2016 and November 2020. We randomly selected patients aged 30-70 years with a high probability of OSA (≥ 3 points on the STOP-Bang questionnaire) who were visiting any of the four PCCs assigned for referral to the University Hospital Doctor Josep Trueta, Girona, Spain. 2599 patients were assessed for eligibility; 403 provided a high probability of OSA and 329 could be compared between PCC and hospital. 210 (63.8%) patients were male and the mean age was 56.5 (SD: 9.2) years. The global agreement between PCC and hospital diagnoses was 41.6% and severe OSA showed the highest level of agreement (96.2%). The Kappa index for severe OSA was 0.46 (95% CI: 0.37, 0.55) and the specificity was 0.99 (95% CI: 0.97, 1.00). The ApneaLink^TM Air device showed high specificity for severe OSA in a high-risk primary care population with a high pre-test probability of OSA. When aHSAT indicates severe OSA, hospital confirmation may be unnecessary, whereas negative or moderate findings may still require specialist assessment.