Cross Nathan E, Harrison Christopher M, Yee Brendon J, Grunstein Ronald R, Wong Keith K H, Britt Helena C, Marshall Nathaniel S
CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, NSW, Australia.
Family Medicine Research Centre of the School of Public Health, The University of Sydney, Sydney, Australia.
J Clin Sleep Med. 2016 Aug 15;12(8):1167-73. doi: 10.5664/jcsm.6060.
To characterize the changes in management of snoring and obstructive sleep apnea (OSA) in general practice in Australia.
The Bettering the Evaluation And Care of Health (BEACH) study is a nationally representative rolling cross-sectional survey of general practice activity in Australia. We analyzed all adult (age 18+ y) encounters for OSA or snoring, annually from 2000 to 2014 (approximately 1,000 general practitioners (GPs) per year recording approximately 100,000 patient encounters per year).
The management rate of OSA rose from 94 to 296 per 100,000 encounters, whereas management rate of snoring remained steady at approximately 15 to 25 per 100,000 encounters. The majority of patients managed for OSA were: middle-aged (25-64 y; 71.3% of all patients); overweight (90%); male (62%), although there was a trend for an increase in the proportion being female over the study period (21 to 37 per 100 encounters). Referral rates were high for both OSA (59 per 100 problems managed) and snoring (69 per 100), although medical referrals (to a sleep clinic or respiratory physician) were significantly higher for patients managed for OSA than for snoring (90% vs. 60% of all referrals). Surgical referrals were higher for snoring than for OSA (37% vs. 3% of all referrals).
The management rate for OSA tripled from 2000 to 2014, while the rate for snoring remained steady. GPs significantly relied on the advice of other health professionals to manage OSA; however, their referral patterns aligned with what most specialists would recommend.
A commentary on this article appears in this issue on page 1081.
描述澳大利亚全科医疗中打鼾和阻塞性睡眠呼吸暂停（OSA）管理方式的变化。
改善健康评估与护理（BEACH）研究是一项对澳大利亚全科医疗活动具有全国代表性的滚动横断面调查。我们分析了2000年至2014年每年所有成年（18岁及以上）因OSA或打鼾的就诊情况（每年约1000名全科医生记录约100000次患者就诊）。
OSA的管理率从每100000次就诊中的94例升至296例，而打鼾的管理率保持稳定，约为每100000次就诊中的15至25例。接受OSA管理的大多数患者为：中年（25 - 64岁；占所有患者的71.3%）；超重（90%）；男性（62%），尽管在研究期间女性比例呈上升趋势（每100次就诊中从21例增至37例）。OSA（每100例管理问题中有59例）和打鼾（每10例中有69例）的转诊率都很高，不过接受OSA管理的患者的医疗转诊（至睡眠诊所或呼吸内科医生）显著高于打鼾患者（占所有转诊的90%对60%）。打鼾的手术转诊率高于OSA（占所有转诊的37%对3%）。
2000年至2014年，OSA的管理率增长了两倍，而打鼾的管理率保持稳定。全科医生在管理OSA时显著依赖其他健康专业人员的建议；然而，他们的转诊模式与大多数专科医生的建议一致。
关于本文的一篇评论发表在本期第1081页。
