Diagnosis and treatment for sleep apnea hypopnea syndrome in primary care

The challenge

Sleep apnea hypopnea syndrome (SAHS) is characterised by repetitive pauses in breathing during sleep, caused by upper airway obstruction.[1] Diagnosis of SAHS requires identifying symptoms like excessive daytime sleepiness, snoring, and gasping during sleep.[2]

Due to variability in how symptoms are presented and a lack of appropriate diagnostic procedures in primary care (PC), SAHS is currently underdiagnosed. Only 10% of cases are correctly diagnosed in Spain, with higher levels of underdiagnosis in Portugal.[3][4]

Existing procedures are performed at hospital sleep units (HSU), leading to significant delays and increased costs.[5] Due to prevalence, technical complexity and high costs, studies and international organisations suggest healthcare pathways initiated in PC should be implemented to increase diagnosis rates and reduce burden on HSU.[6]

Existing platforms and procedures increasingly aim to address individual parts of the patient journey (diagnosis, treatment, monitoring). But none are fully integrated into a single healthcare pathway, nor with electronic health record (EHR) systems.

The solution

Innobics-SAHS addresses these issues by creating an innovative healthcare pathway. To achieve this, the team is developing a digital platform with communication tools for PC and HSU, with integrated data-related tools for diagnosis, treatment, and monitoring. The new healthcare pathway will also include a virtual sleep unit (VSU).

Shared therapeutic procedures, provision of specialised support and exchanging data for patient follow-up are the core aspects of the proposed solution. This new care pathway will facilitate early diagnosis of SAHS, improving integration between PC and HSU. It also has the potential to improve patient outcomes and the patient journey experience.

A shared therapeutic process will improve early diagnosis rates of SAHS in PC, reducing and anticipating neurocognitive alterations and cardiovascular comorbidities.

Following an agile methodology, the solution will be designed, developed, and tested in two regional healthcare ecosystems (Catalonia, Lisbon). International standards for interoperability (the ability of systems to communicate and exchange data without loss of content) will be used. As such, the solution will be able to share data across other regions and EU countries.

Existing products focus on individual stages of the patient journey. For example, screening, diagnosis, treatment. But they do not offer a complete integrated solution. In contrast, Innobics-SAHS will cover the whole patient journey, increasing communication between PC and HSU. It will also boost patient satisfaction, healthcare outcomes and effectiveness.[7]

Expected impact

By improving the ability of PC to diagnose SAHS, this solution has the potential to reduce referrals, decrease waiting lists, cut costs and relieve the pressure on HSU.[8]

As well as improving care pathways, and strengthening healthcare systems, this solution has the potential to improve the quality of life of patients. Not only could it decrease waiting lists, but it could improve healthcare procedures, and decrease the number of patient side effects.

Care pathways for diagnosis and treatment of SAHS will be improved by empowering PC and introducing innovative tools to provide virtual support from the HSU. Continuum of care of SAHS patients will be improved by a better coordination between PC and HSU, relying on the integration and data-sharing through a digital platform and virtual support teams.

Patient monitoring will be performed by professionals at different levels of care. This increases personalisation of care and increases orientation towards health outcomes. In this way, the project also promises to increase efficiency in healthcare resource consumption.

External Partners
  • Fundació TIC Salut i Social
  • Oxigen Salud
  • ResMed Spain
  • Grupo Pulso

[1] Jonathan, C., et al. (2016). Sleep apnoea. European Respiratory Review. 25(139):12-18.

[2] Punjabi, N. (2008).  The Epidemiology of Adult Obstructive Sleep Apnea.  For On the Thorac Soc 2008.  5:136-143.

[3]Rodriguez, A.,  et al. (2017). Obstructive sleep apnea: Epidemiology and Portuguese patients profile.  Portuguese Journal of Pulmonology (English Edition). 23(2):57-61.

[4] Lloberes, Q. (2011).  Diagnosis and treatment of sleep apnea-hypopnea syndrome.  Arch. Bronconeumol.  2011:47(3):143-156

[5] Durán-Cantolla, J., et al. (2004). The Availability in Spanish Public Hospitals of Resources for Diagnosing and Treating Sleep Apnea-Hypopnea Syndrome. Archivos De Bronconeumología (English Edition). 40(6):259-267.

[6] Epstein, L., et al. (2009).  Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. J Clin Sleep Med. 5(3):263-76.

[7] Nagappa, M., et al. (2015). Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis. PLoS One. 10(12):14.

[8] SEPAR. (2020).  Accrediting regulations multidisciplinary units of high complexity. SEPAR. 


Dr. Anton Obrador
| Activity leader and Pneumologist | Institut Català de la Salut
Neus Luque
| Project Manager and Research Assistant IDIBGI | IDIBGI
Jesús Berdún
| Area Manager | Fundació TIC Salut Social