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Identification by Primary Care Clinicians of Patients with Obstructive Sleep Apnea: A practice-based research network (PBRN) study

Background: Obstructive sleep apnea (OSA) is a reasonably common disorder that is associated with daytime tiredness and a host of medical conditions. Little is known about how primary care clinicians (PCCs) detect, diagnose, and manage patients who have OSA. Methods: We gathered information from 44 randomly selected practices in 5 regional practice-based research networks. This included interviews with PCCs and sleep consultants, medical records abstraction, and patient surveys. Descriptive analyses of the quantitative data were used to describe the prevalence of sleep symptoms, the proportion of primary care patients at high risk for OSA, and the methods used by PCCs to detect and diagnose patients with OSA. Results: More than 90% of adult patients visiting a PCC on any given day are experiencing sleep-related symptoms. Based on their Berlin Questionnaire scores, more than one third are at high risk of having sleep apnea. However, most patients have not discussed their sleep-related symptoms with their PCC, and fewer than one third have sleep-related symptoms documented in their medical records. Very few PCCs routinely screen for OSA, and, despite using billing records, problem lists, clinician and staff recall, and prospective logs enhanced by waiting room posters, PCCs were generally unable to identify 25 patients with OSA in their practices. Conclusions: A substantial proportion of patients who see PCCs regularly are at high risk for OSA. Very few of them are being diagnosed or treated. Clearer guidelines and a systematic approach are needed if this is indeed a problem that should be addressed.