Physicians should improve obstructive sleep apnea testing, experts say

Primary care physicians’ and sleep specialists’ adherence to recommendations for diagnosing obstructive sleep apnea was “fair with low failure rates,” according to researchers.

However, they said efforts are needed to improve diagnostic success rates and reduce unnecessary testing.

The findings were initially published in Sleep, the journal of the Sleep Research Society, and presented recently at the society’s annual meeting, which was held virtually.

Ken He

Ken He, MD, PharmD, a physician at the Veterans Affairs Puget Sound Health Care System, and colleagues compared adherence to diagnostic guidelines from the American Academy of Sleep Medicine (AASM) for obstructive sleep apnea and appropriate use of Home Sleep Apnea Testing (HSAT) among PCPs and sleep specialists. Their analysis included 170 patients from rural areas and 125 patients from urban areas who were referred for HSAT with the WatchPAT device (Itamar Medical), a HSAT tool that uses the peripheral arterial signal, heart rate, oximetry, actigraphy, body position, snoring and chest motion to detect obstructive sleep apnea, according to the manufacturer.

Overall, 2% of all patients’ files had no HSAT-related data, which the researchers described as “complete HSAT failure.” PCPs and sleep specialists adhered to the complete HSAT criteria 74% of the time and only 13% of them performed the HSAT recommendation of monitoring patients for at least 4 hours. Other findings showed that:

• 3% of specialists and 21% of PCPs performed unnecessary studies to confirm an obstructive sleep apnea diagnosis;
• 60% of specialists and 64% of PCPs diagnosed obstructive sleep apnea correctly among all comers;
• 65% of specialists and 86% of PCPs diagnosed obstructive sleep apnea correctly among prespecified patients previously diagnosed with obstructive sleep apnea; and
• 77% of specialists and 68% of PCPs followed HSAT criteria in patients without significant comorbidities.

Moving forward, sleep specialists will have an important role in improving obstructive sleep apnea testing, He said.

“Primary care physicians already do a lot in terms of providing comprehensive care,” He said. “Most of the responsibility falls upon sleep providers to help disseminate education on the AASM guidelines.”

According to He, PCPs can use education materials from the Extension for Community Healthcare Outcomes, or ECHO, to enhance their knowledge of sleep disorders. He added that this may become especially important for PCPs in rural areas since the prevalence of obstructive sleep apnea will likely increase in these areas but the number of sleep specialists will not.

“With increased availability of technological advances — high-speed internet, computing power, mobile platforms — telemedicine will become more prevalent and seamless, which will drive more specialists to live in urban centers since they can deliver subspecialty care virtually,” He said.