Obstructive Sleep Apnea (OSA) in Primary Care: Evidence-based Practice

Abstract

This paper presents data evidence supporting the value of diagnosing and treating obstructive sleep apnea (OSA) in reducing morbidity and mortality, improving comorbid disease processes, and improving patient quality of life. These data are derived from a PubMed-based meta-analysis of recent cost effectiveness, standards of practice, and epidemiological studies of OSA, which are ranked using a hierarchical strength of recommendation taxonomy. Cost and health care utilization data have been calculated for OSA and hypersomnolence as well as for diagnostic testing. Strong evidence (which is indicated by a strength of recommendation rating of "A") exists for the association of adult OSA with obesity, daytime sleepiness, hypertension, and motor vehicular accidents. Strong evidence also exists for requiring full-night or split-night attended polysomnography (PSG) for the diagnosis and treatment of adult OSA and for patients with systolic or diastolic heart failure not responding to optimal medical management. Good evidence (B) exists for the association of adult OSA with congestive heart failure, coronary artery disease, cerebral vascular accidents, metabolic syndrome, and increased mortality. Good evidence also exists to indicate that the nonattended PSG can be used to diagnose sleep breathing disorders, that autotitration systems can be used to titrate continuous positive airway pressure ( This year the field of sleep medicine becomes a fully accredited American Medical Association subspecialty and an area of potential subspecialization for family physicians interested in a Certificate of Added Qualification (CAQ) in sleep medicine. The field of sleep medicine has shown remarkable growth in the last decades. The number of boardcertified sleep physicians have grown from Ͻ500 to Ͼ3000 in the last 15 years. Yet the overwhelming majority of people who suffer from disorders of sleep and wakefulness are undiagnosed and untreated. The field is relatively new, with few physicians having expertise or training in the area because sleep medicine is not regularly taught in medical schools or in physician training programs.Many practicing physicians complete training without a clear understanding of obstructive sleep apnea (OSA), the most physiologically disruptive and dangerous of the sleep-related diseases (Table 1). 1Most patients with sleep disturbance receive their medical care in the primary care setting. Life stressors, concomitant illness, and family and social structure can precipitate sleep complaints. The primary care physician often has a more complete knowledge of these factors than the polysomnographic-oriented sub-specialist. This paper presents evidence data documenting the importance of the diagnosis and treatment of OSA in reducing morbidity and mortality, improving comorbid disease processes, and improving patient quality of life in the primary care setting. These data are derived from a PubMed-based meta-analysis of recent cost effectiveness, standards of practice, and epidemiologic studies of OSA, which are ...

Social consequences of sleep disordered breathing on patients and their partners: a controlled national study

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Sleep Apnea and Glaucoma – Greater Risk for Blacks?

“…Sleep apnea is thought to be as prevalent as adult diabetes and might affect more than 18 million Americans [6,33]. Others view it as big a public health hazard as smoking [34], in part because of associated residual daytime sleepiness [18,29]. The National Commission on Sleep Disorders Research estimated that sleep apnea is probably responsible for 38,000 cardiovascular deaths yearly, with an associated 42 million dollars spent on related hospitalizations [35].…”

“…Sleep apnea is also associated with a number of metabolic diseases [21][22][23][24][25][26][27][28], cardiac arrhythmias [18,19], cardiovascular disease [18,20], decreased quality of life [17] and early mortality [18,28]. It causes significant sleep disturbances and excessive daytime sleepiness [18,29], which often lead to road traffic and industrial accidents [18,27,30] as well as cognitive deficits and poor performance [31]. Sleep apnea is also associated with numerous psychiatric comorbid diagnoses including depression (21.8%), anxiety (16.7%), posttraumatic stress disorder (11.9%), psychosis (5.1%), and bipolar disorders (3.3%).…”

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