The snoring and sleep apnoea disorders service
United Lincolnshire Hospitals NHS Trust
What is the snoring and sleep apnoea disorders service?
The Snoring Disorders Centre was set up to diagnose and treat various sleep problems including sleep apnoea and snoring. The centre is led by consultant ENT surgeons and provides accurate and prompt diagnosis and treatment of sleep disorders.
Until the Snoring Disorders Centre was set up, there was no obstructive sleep apnoea (OSA) service in Lincolnshire which has a catchment of around 700,000 people. Patients were referred to Nottingham, Leicester or Cambridge which often meant a full-day round trip for a routine outpatient appointment. Appointments could take several months to come through and patients would need to take time off work.
Sleep disorders are very common and although OSA affects up to 4% of the population, often people aren't aware that they are suffering. OSA can increase the risk of heart attack, stroke, untreatable hypertension, memory impairment, dementia, and can also contribute to weight gain in later life.
The Snoring Disorders Centre provides patients with a local, accessible and friendly service. It also allows the vast majority of diagnostics and treatment to be given in the patient's own home with the intention of minimising hospital attendances. This reduces outpatient appointments and has resulted in a reduction in sleepiness and an improvement in the quality of life.
For 90% of patients, medical management is the most appropriate course of action and they are helped with advice and support on weight loss and lifestyle changes, or alternatively Continuous Positive Airway Pressure (CPAP) machines are issued. For the 10% of patients who need surgical intervention, they are admitted overnight, reviewed swiftly, and the appropriate treatment regime is put in place.
Who was involved?
The team consists of three consultants, four associate specialists and two specialist nurses.
The service was developed in collaboration with patients, local GPs, Lincolnshire PCT, Lincolnshire Road Safety Partnership, United Lincolnshire Hospitals NHS Trust (ULHT) management - particularly the Chief Executive Officer, Medical Director and Director of Finance - and the Bostonian Private Wing of ULHT.
The centre provides morning, afternoon and evening clinics, however the majority of clinics take place in the evening so patients don't have to take time off work. First appointments for routine referrals are provided within two weeks. Urgent cases, eg patients who drive long distances on a regular basis, are offered quicker appointments.
The Snoring Disorders Centre has also opened a new satellite clinic at Johnson Hospital in Spalding to give sufferers of sleep apnoea from South Lincolnshire and North Cambridgeshire easy access to a high quality treatment service.
Patients were previously admitted overnight for sleep investigations in non-local hospitals. In a large percentage of cases, the centre can provide a portable home sleep study which is sufficient to capture the diagnostic information needed. For the remaining patients who need to be admitted, this is done locally in the Bostonian in a comfortable private room.
The Driver and Vehicle Licensing Agency (DVLA) requires parients to be compliant with treatment to drive. Patients previously had to attend hospitals in different areas of the country for data to be downloaded and reports produced to allow them to continue driving. Using smartcard technology, the consultant can now monitor patient compliance with their daily treatment via a secure web server without the patient having to attend at hospital.
The CPAP machines log how many hours of sleep a patient has and automatically correct each OSA episode during the night.
Michael Oko, Consultant ENT Surgeon at United Lincolnshire Hospital Trust, says: "At the click of a mouse, I can tell how many hours per night my patients are using their machines for, and if there was any interruption of its usage. The patients know this and I think it has a positive effect on the use of the therapy. We electronically track over 1,200 patients and follow up appointments are normally carried out over the phone, reducing the need for hospital attendances. We also provide a free telephone support helpline for patients on CPAP."
CPAP machines are leased rather than bought so all maintenance, insurance and upgrades are the responsibility of the manufacturere. Stocks of several types of masks are also kept in the hospital and dispatched to patients on request.
Michael says: "Occupational road related deaths and accidents in Lincolnshire average about 79 per year. 20% of car accidents are shown to be sleep related, although it's uncertain how many are due to obstructive sleep apnoea. The Department for Transport estimates the total cost of each fatal accident (including human cost, lost output and resource cost) to be around £1.6 million, so every accident prevented is of significant benefit to society and to the NHS. Many of our patients admit to feeling drowsy at the wheel."
By December 2010, the average number of fatal road traffic accidents had fallen from 79 to 45. This represents a saving of almost £55 million to the economy, including the NHS. A contributory factor may be that the service has treated over 1,200 patients with sleep apnoea and these people are now able to drive more safely, rather than being in fear of falling asleep at the wheel.
One patient who drives 50,000 miles a year for work said using the CPAP machine to treat his sleep apnoea has turned his life around: "For four or five years, I struggled to sleep and I used to need two naps every day just to get through the day. My GP referred me to Mr Oko when I said I had trouble sleeping. Within weeks he got me on a CPAP machine which I use every night and I've never looked back. It's made a huge difference to my life."
Mr Oko plans to expand the service to other regions out of Lincolnshire, as well as continuing to promote the service and increase the number of patients the centre can help.
Key learning points
"Involve your Chief Executive, Medical Director and Director of Finance", advises Michael. "Come up with lots of ideas as well, even if they don't all seem possible. If you believe in your work, and you're confident you can do it, others will believe in it too - don't be disillusioned. And I can't stress how important patient satisfaction is - continually involve them and ask for feedback to improve your service. Don't underestimate the value of the web and social media. People use facebook and twitter, and they're an invaluable way of getting your message out there." 96% of patients at the Snoring Disorders Centre have rated the service as excellent or very good.
Mr Michael Oko
Consultant ENT Surgeon
Tel: 01205 364801 begin_of_the_skype_highlighting 01205 364801 end_of_the_skype_highlighting
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