9.1 Local implementation

Implementation of national clinical guidelines is the responsibility of each NHS Trust and is an essential part of clinical governance. It is acknowledged that every Trust cannot implement every guideline immediately on publication, but mechanisms should be in place to ensure that the care provided is reviewed against the guideline recommendations and the reasons for any differences assessed and, where appropriate, addressed. These discussions should involve both clinical staff and management. Local arrangements may then be made to implement the national guideline in individual hospitals, units and practices, and to monitor compliance. This may be done by a variety of means including patient-specific reminders, continuing education and training, and clinical audit.

9.2 Resource implications

Recommendations likely to be associated with additional resource use for NHSScotland are highlighted in Annex 2. There are likely to be corresponding reductions in costs associated with cardiovascular and pulmonary diseases in patients with OSAHS and in road traffic accidents, associated with treating these conditions.

9.3 Key points for audit

• Availability of specific diagnostic tests and treatment options for OSAHS
• Proportion of patients with a positive diagnosis of OSAHS receiving treatment according to locally agreed protocols
• Proportion of patients with OSAHS using CPAP for more than two hours each night
• Proportion of patients being treated with CPAP who are using a heated humidifier system to aid compliance
• Proportion of patients with OSAHS failing to tolerate IODs and CPAP and the underlying reasons for failure
• Determination of frequency, nature and outcome of the surgery that is being performed for the treatment of OSAHS and snoring
• Proportion of postoperative patients suffering from previously undiagnosed OSAHS

9.4 Recommendations for research

• Identification of the severity threshold for long term benefits from treatment for OSAHS
• Large scale trials comparing the benefits of treatments proven to be effective in OSAHS
• Evaluation of the cost effectiveness of treating OSAHS and screening in high risk groups (eg professional drivers and pilots)
• Clarification of the causes of excessive sleepiness whilst driving
• Improving the available subjective and objective tests to accurately assess whether patients are safe to drive
• Clarification of the mechanism of the association between OSAHS and hypertension
• Assessing whether OSAHS predisposes to myocardial infarction and stroke
• Assessment of the role of nurse led clinics in the diagnosis and subsequent management of patients with OSAHS
• Assessment of efficacy of algorithms for the diagnosis and treatment of OSAHS
• Comparison of hospital vs home titration of CPAP pressures in the management of OSAHS
• Comparison of treatment outcomes of conventional vs “smart” autotitrating CPAP in the management of OSAHS