Recognizing and Managing Obstructive Sleep Apnea in Primary Care

Abstract

Objective: This review aims to impart information regarding recognition of obstructive sleep apnea (OSA) and associated excessive sleepiness (ES) in the primary care setting in order to provide optimal care to patients with this common but serious condition. This review will also discuss the prevalence and treatment of depression in patients with OSA.Data Sources: A MEDLINE search of articles published between 1990 and 2008 was conducted using the search terms obstructive sleep apnea AND excessive sleepiness, obstructive sleep apnea AND depression, and obstructive sleep apnea AND primary care. Searches were limited to articles in English concerned with adult patients.Study Selection: In total, 239 articles were identified. Articles concerning other sleep disorders and forms of apnea were excluded. The reference lists of identified articles were searched manually to find additional articles of interest.Data Synthesis: Primary care physicians can aid in the diagnosis of OSA and associated ES by being vigilant for lifestyle and physical risk factors associated with this condition. In addition, primary care physicians should maintain a high level of clinical suspicion when presented with illnesses that are commonly comorbid with OSA, such as psychiatric disorders and depression, in particular. Conversely, assessment of patients with OSA for common comorbidities may also improve a patient's prognosis and quality of life.Conclusions: Primary care physicians play a vital role in recognizing OSA and ES. These clinicians are crucial in supporting their patients during treatment by ensuring that they have clear, concise information regarding available therapies and the correct application and maintenance of prescribed devices.

Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis

“…111 Such programs will likely increase testing, optimize the use of diagnostic resources and expedite treatment. [112][113][114] Our findings confirm those of previous reviews, health technology assessments and clinical practice guidelines based on earlier evidence of portable monitor use in the diagnosis of sleepdisordered breathing. [25][26][27][31][32][33][34][35][36][37][38][39]115 These reviews concluded that level 3 devices are useful in the diagnosis of obstructive sleep apnea in patients with a high pretest likelihood of having moderate to severe forms of the condition.…”

Prevalence and Predisposing Factors for Depressive Status in Chinese Patients with Obstructive Sleep Apnoea: A Large-Sample Survey

“…The prevalence rate of depression in OSA patient was 5%–63%[ 30 ], higher compared with patients without OSA that was generally 1.8%–3.3%[ 31 ]. Previous studies in China also found the similar results.…”

Tracking Pulse Oximeter Findings Before, During and After Titration of Mandibular Advancement Devices (MAD) for Patients With Mild to Moderate Obstructive Sleep Apnea (OSA)

“…AP AP devices detect the variability of aitway resistance on a breath to breath basis, and vary the air pressure to provide the lowest and most comfortable positive pressure needed to keep the ai1way patent. These alternative PAP devices may be better tolerated than the CPAP (Culpepper & Roth, 2009).…”

“…A MAD is fitted to the maxillary and mandibular dentition, worn at night and can be variably adjusted to move the lower jaw forward and advance the base of the tongue. Such forward positioning increases pharyngeal airway space and reduces airway instability (Chan et al, 2007;Culpepper & Roth, 2009;Dieltjens et al, 2012).…”