Department of Public Health Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada.
Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan S7N 2Z4, Canada.
Can Respir J. 2019 Jan 14;2019:1683124. doi: 10.1155/2019/1683124. eCollection 2019.
Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. Patients with OSA symptoms are often not diagnosed clinically, which is a concern, given the health and safety risks associated with unmanaged OSA. The availability of fewer practicing medical specialists combined with longer travel distances to access health care services results in barriers to diagnosis and treatment in rural communities. This study aimed to (1) determine whether the proportion of adults reporting OSA symptoms in the absence of a sleep apnea diagnosis in rural populations varied by travel distance to specialist medical care and (2) assess whether any distance-related patterns were attributable to differences in the frequency of diagnosis among adults who likely required this specialist medical care. We used a cross-sectional epidemiologic study design, augmented by analysis of follow-up survey data. Our study base included adults who completed a 2010 baseline questionnaire for the Saskatchewan Rural Health Study. Follow-up occurred until 2015. 6525 adults from 3731 households constituted our sample. Statistical models used log-binomial regression. Rural adults who reported the largest travel distances (≥250 km) to specialist medical care were 1.17 (95% CI: 1.07, 1.29) times more likely to report OSA symptoms in the absence of a sleep apnea diagnosis than those who reported the smallest (<100 km; referent) distances. However, the proportion of sleep apnea diagnoses was low and unaffected by reported travel distance among adults who likely required this specialist medical care. Our findings suggest factors other than travel distance may be contributing to the low sleep apnea diagnostic rate. This remains important as undiagnosed and untreated OSA has serious implications on the health of people and populations, but effective treatments are available. Health care access barriers to the diagnosis and treatment of OSA require evaluation to inform health care planning and delivery.
阻塞性睡眠呼吸暂停（OSA）是最常见的睡眠呼吸紊乱疾病。有 OSA 症状的患者在临床上往往得不到诊断，这令人担忧，因为未经治疗的 OSA 会带来健康和安全风险。由于能够提供医疗服务的医学专家较少，加上前往医疗机构的路程较长，这导致农村社区在诊断和治疗方面存在障碍。本研究旨在：(1) 确定在农村人群中，没有睡眠呼吸暂停诊断的成年人报告 OSA 症状的比例是否因前往专科医疗的距离而异；(2) 评估任何与距离相关的模式是否归因于那些可能需要这种专科医疗的成年人中诊断频率的差异。我们采用了横断面流行病学研究设计，并结合对后续调查数据的分析。我们的研究基础包括完成萨斯喀彻温农村健康研究 2010 年基线问卷调查的成年人。随访至 2015 年。我们的样本由来自 3731 户家庭的 6525 名成年人组成。统计模型采用对数二项式回归。与报告最小距离（<100km；参照）的成年人相比，报告前往专科医疗的最大距离（≥250km）的农村成年人报告 OSA 症状而无睡眠呼吸暂停诊断的可能性高出 1.17 倍（95%CI：1.07，1.29）。然而，在那些可能需要这种专科医疗的成年人中，睡眠呼吸暂停的诊断比例较低，且不受报告的旅行距离影响。我们的研究结果表明，除了旅行距离之外，可能还有其他因素导致睡眠呼吸暂停的低诊断率。这仍然很重要，因为未确诊和未经治疗的 OSA 会对个人和人群的健康产生严重影响，但有效的治疗方法是可用的。需要评估阻塞性睡眠呼吸暂停的诊断和治疗的医疗保健获取障碍，以告知医疗保健规划和交付。
