From the Department of Family Medicine, Henry Ford Hospital, Detroit, MI (BA, KZ, NB, DW-P, and KB);Department of Medical Education, Henry Ford Hospital, Detroit, MI (KDP); Department of Public Health Sciences, Henry Ford Health System, Detroit, MI (LL and DR); and Wayne State University, Detroit, MI (AS).
J Am Board Fam Med. 2022 Mar-Apr;35(2):320-328. doi: 10.3122/jabfm.2022.02.210296.
The exact prevalence of obstructive sleep apnea (OSA) is unknown, and primary care providers are left with conflicting guidance on screening criteria from various institutions. The purpose of this study was to identify health care gaps in OSA diagnosis for patients at high risk of OSA.
A retrospective medical record review was performed assessing adult patients (≥ 18 years) who had outpatient visits in family medicine clinics, located in the cities of Detroit, Troy, and Commerce, Michigan in 2018. The primary outcome was the number of patients assessed for OSA. Patients determined as high risk for OSA had at least 3 of the following criteria: (1) hypertension, (2) age 50 years and older, (3) male gender, and (4) body mass index > 35 kg/m. Statistical approach included univariate and logistic regression analysis. Manual chart review of 200 randomly selected records was performed to determine the most common reasons for OSA screening.
Out of 30,022 patients, 4,911 (16.4%) were at high risk for OSA, of which 1,524 (31.0%) were assessed for OSA. Logistic regression analysis of high-risk patients revealed that male sex (odds ratio, 1.84; 95% CI, 1.51-2.26; < ) and body mass index > 35 kg/m (odds ratio, 4.96; 95% CI, 4.04-6.09; < ) were significantly associated with OSA evaluation. Race was not associated with OSA assessment.
Because many individuals at high risk for OSA are not referred for evaluation, improved guidance on OSA screening based on objective risk factors is needed.
阻塞性睡眠呼吸暂停（OSA）的确切患病率尚不清楚，基层医疗机构在筛查标准方面面临着不同机构的相互矛盾的指导。本研究旨在确定高危 OSA 患者的 OSA 诊断中的医疗保健差距。
对 2018 年在密歇根州底特律、特洛伊和商业城的家庭医学诊所进行门诊就诊的成年患者（≥18 岁）进行回顾性病历审查。主要结局是评估 OSA 的患者数量。被确定为 OSA 高危的患者至少有以下 3 个标准：（1）高血压，（2）年龄 50 岁及以上，（3）男性，和（4）BMI＞35kg/m。统计方法包括单变量和逻辑回归分析。对 200 份随机记录进行了手动图表审查，以确定 OSA 筛查的最常见原因。
在 30022 名患者中，有 4911 名（16.4%）患有 OSA 的高危人群，其中 1524 名（31.0%）接受了 OSA 评估。对高危患者的逻辑回归分析显示，男性（比值比，1.84；95%置信区间，1.51-2.26； < ）和 BMI＞35kg/m（比值比，4.96；95%置信区间，4.04-6.09； < ）与 OSA 评估显著相关。种族与 OSA 评估无关。
由于许多患有 OSA 高危的人未被转介进行评估，因此需要基于客观危险因素的 OSA 筛查的改进指南。
