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Naomi R. Kramer, MD; Thorley E. Cook, DO; Carol C. Carlisle, RN; R. William Corwin, MD; Richard P. Millman, MD

Arch Intern Med. 1999;159:965-968.

Background  Obstructive sleep apnea (OSA) is a common disorder among middle-aged adults. However, OSA is a recently described disorder for which most primary care physicians do not have formal training. The primary objectives of this article are to evaluate what percentage of patients referred by primary care physicians for sleep studies had OSA; to characterize the clinical features of these patients and compare them with our known OSA population; and to determine whether primary care physicians asked key questions contained in a work sheet to make the diagnosis of OSA.

Methods  A retrospective chart review at a hospital-based sleep center that is accredited to evaluate all sleep disorders, not just OSA. The health maintenance organization is a staff model one.

Patients  Sixty-nine patients who were referred for a sleep study by a health maintenance organization internist or family practitioner between June 1, 1994, and May 30, 1995.

Results  Ninety-six percent of the 68 patients referred for polysomnography had OSA. Most were very symptomatic and obese. These 68 patients represent 0.13% of the primary care patient panel. In addition, most of the patients were referred by a few physicians; 6 (11%) of the 55 physicians ordered 33% of the 68 studies.

Conclusions  Primary care physicians did recognize obese patients with prominent symptoms of sleep apnea. However, only a small percentage of their patient panel was referred, suggesting that this condition is still underdiagnosed. This seems particularly true as most of the sleep studies were ordered by a small group of physicians. Future work incorporating educational interventions is necessary to improve detection and treatment of OSA.

From the Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital and Brown University School of Medicine (Drs Kramer, Cook, and Millman, and Ms Carlisle), and Harvard Pilgrim Health Care of New England, Brown University (Dr Corwin), Providence, RI.

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