Many primary care patients are at risk for obstructive sleep apnea, but few are sent for testing
Research Activities, July 2011, No. 371
A new study reveals that about 40 to 50 percent of adult patients visiting primary care clinicians on any given day are at high risk of having obstructive sleep apnea (OSA)—a condition caused by temporary restriction of air intake during sleep. If asked, 90 percent of them have worrisome symptoms. Yet, only 20 percent mention these symptoms during their primary care visits. As a result, these patients continue to struggle with excessive daytime sleepiness (and related traffic accidents), impaired thinking, mood disorders, insomnia, and increased risk of hypertension, ischemic heart disease, or stroke. Only 23 percent of the participating primary care clinicians surveyed routinely screen patients for OSA. Instead, they tend to use reviews of symptoms during annual exams and risk factors (e.g. obesity, large neck size, diabetes, etc.) to identify high-risk patients.
The researchers interviewed 18 sleep consultants, who reported that 67 percent of their referrals came from primary care clinicians; 85 percent of the referred patients tested positive for OSA. The researchers analyzed patient medical charts and interview and survey data from patients and clinicians in primary care practices associated with five practice-based research networks located in Oklahoma, Florida, Alabama, Connecticut, and California.
Based on their findings, the researchers recommend the development of clearer guidelines and a systematic approach to screening patients for OSA. The study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 290-07-10009).
More details are in "Identification by primary care clinicians of patients with obstructive sleep apnea: A practice-based research network (PBRN) study," by James W. Mold, M.D., M.P.H., Craig Quattlebaum, M.S., Eric Schinnerer, M.S., and others in the March/April 2011 Journal of the American Board of Family Medicine 24(2); pp. 138-145.