Obstructive sleep apnea (OSA) diagnosis and care models rely on sleep specialist physicians (SSPs) and can be expensive and inefficient.

To assess OSA case-finding accuracy and comparative effectiveness of care by non–sleep specialists (NSSs) and SSPs.

MEDLINE and CINAHL from January 2000 through July 2017.

English-language trials or observational studies comparing case finding or care by SSPs versus providers not specifically trained as SSPs (NSSs) for adults with suspected or diagnosed OSA.

One investigator extracted data and assessed risk of bias and strength of evidence, with confirmation by a second investigator. Primary outcomes were patient-centered (mortality, access to care, quality of life, patient satisfaction, adherence, symptom scores, and adverse events). Intermediate outcomes included resource use, costs, time to initiation of treatment, and case finding.

Four observational studies (n = 580; mean age, 52 years; 77% male) reported good agreement between NSSs and SSPs on appropriate diagnostic testing and classification of OSA severity (low-strength evidence). Five randomized trials and 3 observational studies (n = 1515; mean age, 52 years; 68% male) found that care provided by NSSs and SSPs resulted in similar quality of life, adherence, and symptom scores (low-strength evidence). Evidence was insufficient for access to care and adverse events.

Many outcomes were reported infrequently or not at all. Many NSSs had extensive training or experience in sleep medicine, which limits generalizability of findings to providers with less experience.

Care by NSSs and SSPs resulted in similar outcomes in adults with known or suspected OSA. Studies are needed to determine care model implementation and reproducibility of results in nonacademic settings and among less experienced NSSs.

Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO: CRD42016036810 [full Veterans Affairs Evidence-based Synthesis Program report])

阻塞性睡眠呼吸暂停（OSA）诊断和护理模型依赖于睡眠专科医生（SSP），价格昂贵且效率低下。

评估非睡眠专家（NSS）和SSP在OSA中发现病例的准确性和比较效果。

MEDLINE和CINAHL从2000年1月至2017年7月。

针对可疑或确诊OSA的成年人，比较SSP与未经过专门培训的SSP（NSS）提供者的案例发现或护理的英语语言试验或观察性研究。

一名调查员提取了数据并评估了偏见和证据强度的风险，并由另一名调查员进行了确认。主要结局以患者为中心（死亡率，就医机会，生活质量，患者满意度，依从性，症状评分和不良事件）。中间结果包括资源使用，成本，开始治疗的时间和发现病例。

四项观察性研究（n  = 580；平均年龄，52岁； 77％的男性）报告说，NSS和SSP在适当的诊断测试和OSA严重性分类（低强度证据）上有很好的一致性。五项随机试验和三项观察性研究（n  = 1515；平均年龄，52岁； 68％的男性）发现，NSS和SSP提供的护理可产生相似的生活质量，依从性和症状评分（低强度证据）。证据不足以获取护理和不良事件。

很少或根本没有报告许多结果。许多NSS在睡眠医学方面接受了广泛的培训或经验，这将结果的普遍性限于经验不足的医疗服务提供者。

NSS和SSP的护理在已知或怀疑OSA的成年人中产生了相似的结果。需要进行研究以确定在非学术环境中以及经验不足的NSS中护理模型的实施和结果的可重复性。

退伍军人事务部，退伍军人健康管理局，研究与发展办公室，质量增强研究计划。（PROSPERO：CRD42016036810 [完整的退伍军人事务基于证据的综合计划报告]）