1 Department of Internal Medicine, Division of Pulmonary, Critical Care and Allergy and Immunology, and.
2 Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Ann Am Thorac Soc. 2016 Nov;13(11):2027-2034. doi: 10.1513/AnnalsATS.201603-152OC.
Little is known about recent trends in physician reporting of sleep apnea during outpatient practice visits.
To assess trends in the frequency of adult outpatient visits for sleep apnea in the United States, the clinicians who provided those visits, and the characteristics of patients reported to have sleep apnea; and to assess whether the reporting of a diagnosis of sleep apnea varies across regions of the country as a function of body weight and insurance status.
We reviewed annual stratified samples of patients identified as having sleep apnea during physician office visits in the U.S. National Ambulatory Medical Care Survey database, and during visits to hospital outpatient practices in the U.S. National Hospital Ambulatory Medical Care Survey database, between 1993 and 2010. The aggregate data set included records of 838,000 ambulatory practice visits.
During this 17-year period, survey reports of a diagnosis of sleep apnea increased 14.6- fold, from 420,000 to 6.37 million per year (P = 0.0002). Thirty-three percent were reported by primary care providers, 17% by pulmonologists, and 10% by otolaryngologists. Over the period of observation, reports of a diagnosis of sleep apnea by "other groups" increased considerably (P < 0.001). The per capita rate of sleep apnea diagnoses per 1,000 persons per year differed across regions of the United States (P < 0.0001). Regions that reported a higher rate of sleep apnea appeared to be influenced by obesity (P < 0.001) and health insurance status (P < 0.005).
Diagnoses of sleep apnea during outpatient visits to hospital-based and non-hospital-based practices in the United States were much more frequent in 2010 than in 1993, as reported by outpatient practice clinicians participating in national surveys. Although the majority of diagnoses of sleep apnea were reported by primary care providers, pulmonologists, and otolaryngologists (60%), there was a substantial increase in reports of sleep apnea by clinicians practicing other specialties during the study period. Reporting of a diagnosis of sleep apnea varied by obesity prevalence and health insurance status across U.S. geographic regions.
对于美国门诊就诊中医生报告睡眠呼吸暂停的最新趋势，我们知之甚少。
评估美国成人睡眠呼吸暂停门诊就诊频率、提供这些就诊的临床医生以及报告患有睡眠呼吸暂停的患者特征的趋势；并评估诊断为睡眠呼吸暂停的报告是否因体重和保险状况的不同而在美国不同地区有所差异。
我们对 1993 年至 2010 年期间美国国家门诊医疗调查数据库中记录的在医生办公室就诊时以及美国国家医院门诊医疗调查数据库中记录的在医院门诊就诊时被诊断为睡眠呼吸暂停的患者进行了年度分层抽样调查。综合数据集包括 838000 次门诊就诊记录。
在这 17 年期间，调查报告中诊断为睡眠呼吸暂停的病例增加了 14.6 倍，从每年 420000 例增至每年 6370000 例（P = 0.0002）。33%的病例由初级保健提供者报告，17%的病例由肺病专家报告，10%的病例由耳鼻喉科医生报告。在观察期间，“其他群体”报告的睡眠呼吸暂停诊断数量显著增加（P < 0.001）。美国不同地区的睡眠呼吸暂停诊断率存在差异（P < 0.0001）。报告的睡眠呼吸暂停发生率较高的地区似乎受到肥胖症（P < 0.001）和健康保险状况（P < 0.005）的影响。
与 1993 年相比，美国基于医院和非医院的门诊就诊中报告的睡眠呼吸暂停诊断在 2010 年更为常见，这是参与全国调查的门诊临床医生报告的结果。尽管大多数睡眠呼吸暂停诊断是由初级保健提供者、肺病专家和耳鼻喉科医生（60%）报告的，但在研究期间，报告睡眠呼吸暂停的其他专业临床医生的数量显著增加。在美国不同地区，睡眠呼吸暂停的诊断报告因肥胖流行率和健康保险状况而异。
