Chest
Volume 121, Issue 6, June 2002, Pages 1741-1747
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Clinical Investigations
Sleep and Breathing
Increased Physician-Reported Sleep Apnea: The National Ambulatory Medical Care Survey

https://doi.org/10.1378/chest.121.6.1741Get rights and content

Background

Despite increased recognition of sleep apnea as a major health problem, little is known about physician practice patterns regarding this condition.

Methods

We used the National Ambulatory Medical Care Survey (NAMCS) data between the years of 1990 to 1998, a weighted estimate of the frequency of physicians' diagnoses nationwide in their outpatient practices, to address the following questions: (1) has there been an increase in physician reporting of sleep apnea, (2) which physicians reported diagnoses of sleep apnea, and (3) what are the demographic characteristics of patients with diagnoses of sleep apnea?

Results

During this 9-year period, there was a 12-fold increase in the diagnosis of sleep apnea in outpatients, from 108,121 to 1,305,624 diagnoses (p < 0.001). Among other primary sleep disorders, only insomnia had an increase in reporting (fourfold, p < 0.001). Report of sleep apnea was greatest among primary care providers (37%), pulmonologists (24%), and otolaryngologists (18%). Sleep apnea was reported more often in men than in women (3:1, respectively), and 80% of diagnoses occurred in the following age groups: 30 to 39 years (12%), 40 to 49 years (33%), 50 to 59 years (27%), and 60 to 69 years (12%). Conditions associated with sleep apnea included hypertension (10%), obesity (6%), and COPD (7%). Increased reporting of sleep apnea by NAMCS physicians was associated with increases in the number of accredited sleep laboratories and the number of sleep publications in the medical literature during the period of review (p < 0.001).

Conclusion

Sleep apnea is recognized increasingly by physicians. Further investigation is necessary to define those factors that influence physician recognition and reporting of sleep apnea, and approaches associated with optimum patient outcomes.

Section snippets

Database

The National Ambulatory Medical Care Survey (NAMCS) is a national survey of office-based physicians conducted by the National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention. This survey contains data on individual outpatient office visits and is then weighted to reflect national estimates describing the use of ambulatory medical care services in the United States. Using NAMCS data, questions regarding patterns of reporting disease, disease-specific

Annual Frequencies of Reporting Sleep Apnea and Other Common Diseases

During the 9-year period, we queried the frequency of sleep apnea and common diseases diagnosed yearly and whether there was a change over time. Sleep apnea was noted as a primary, secondary, or tertiary diagnosis in 4.83 million visits (0.8% of the total). There was a 12-fold increase (from 110,000 to 1.3 million, p < 0.0001) in the number of sleep apnea diagnoses reported per year (Fig 1). By contrast, the frequencies with which common diseases including upper respiratory tract infection

Discussion

Sleep apnea, a condition of major societal importance, has been estimated to be an as prevalent (2 to 4%) as another common respiratory condition, asthma.1,2 The economic cost sleep apnea imposes on our health-care system and society has been estimated in the billions of dollars.2,10 Despite this impact, physicians underrecognize the disease.19,21,22,23,24 Several measures have been implemented to increase both physician and patient awareness of sleep apnea,2,16 but little is known about the

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