P202 Clinics for obstructive sleep apnoea hypopnoea (OSAH)—time for a change?

Introduction OSAH is a significant public health problem. Growing awareness and rising prevalence is increasing demand for sleep services. Many Trusts are unable to expand existing clinic space to meet this demand. In its recent White Paper 1 , the Government laid out its vision of a patient-centred NHS, pledging patients more choice and control over decision making about their care. However, a sizeable proportion of patients with suspected OSAH are from the working population, yet the NHS does not routinely provide clinics outside normal working hours. Method Patients referred for suspected OSAH were randomly appointed to either daytime or evening clinics. Over a 3-month period, opinions of this out-of-hours service and problems encountered on attending the clinics were surveyed by questionnaire completed by patients in the waiting room. Results Of 165 patients appointed, 156 attended and 136 (87%) completed questionnaires (mean age 50.4 years (range 18–75), 74% male). Over half (57% [77/136]) were in employment of which 21% (16/77) worked shifts and 79% (61/77) days. The rest (59/136 (43%)) were non-working due to disability (42% (24/59)), retirement (39% [23/59]), were full-time carers (10% [6/59]) or were unemployed (8% [5/59]). Patient responses are detailed in Abstract P202 Table 1. In addition, 41% (13/32) of workers seen in evening clinics felt that work would have been a problem if attending in the day. DNA rates were higher for daytime clinics (7%) than evenings (3%). The proportion of workers in the DNAs was unknown. Conclusions There is a considerable demand for out-of-hours sleep clinics. This is predominantly from those in employment. Making up a large proportion of patients referred for suspected OSAH, over half of these patients preferred evening clinics. Provision of this clearly demanded service requires a change in current working practice. Not only would out-of-hours clinics be a move towards delivering the patient-centred NHS pledged in the recent Government White Paper 1 , but would deliver the increased clinic capacity required to meet rising demand.