Chest
Volume 124, Issue 4, October 2003, Pages 1406-1414
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Clinical Investigations
Sleep and Breathing
Prevalence of Symptoms and Risk of Sleep Apnea in Primary Care

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Background

To obtain prevalence estimates for key symptoms and features that can indicate the presence of obstructive sleep apnea (OSA) in a broad range of primary care settings.

Design

Cross-sectional survey.

Setting

Forty offices and clinics in the United States, Germany, and Spain.

Participants

Consecutive patients who were > 15 years of age, regardless of the reason for the visit.

Measurements

We collected demographic information, prevalence of self-reported chronic snoring, sleepiness, obesity (body mass index [BMI] > 30), hypertension, and calculation of OSA risk, and we also compared results between the United States and Europe.

Results

There was a 78% return rate for 8,000 surveys (mean age, 51 years; age range, 15 to 98 years; 52% women). One third of participants (32%) had a high pretest probability for OSA, with a higher rate in the United States (35.8% of 3,915 participants) than in Europe (26.3% of 2,308 participants; p < 0.001; age-matched and sex-adjusted odds ratio [OR], 1.37; 95% confidence interval [CI], 1.16 to 1.61). Sleepiness (32.4% vs 11.8%, respectively; p < 0.001) followed by obesity and/or hypertension (44.8% vs 37.1%, respectively; p < 0.01) contributed to the OSA risk difference between participants in the United States and Europe, as frequent snoring and breathing pauses were similarly reported (44%). A high pretest probability for OSA was more often present in men than in women (37.9% vs 27.8%, respectively; p < 0.005; OR, 1.96; CI, 1.59 to 2.88) and in those that were obese (ie, BMI, ≥ 30 kg/m2), a condition that is generally more common in the US population than in the European population (27.9% vs 17.2%, respectively; p < 0.01).

Conclusions

Primary care physicians in the United States and Europe will encounter a high demand for services to confirm or manage sleep apnea, sleepiness, and obesity.

Section snippets

Materials and Methods

The survey was conducted over a 2-year period (from 1997 to 1999) in 40 offices and clinics. Local Sleep in Primary Care Study Group members with expertise in pulmonary and sleep medicine identified one to two offices or clinics where a physician had practiced adult general medicine for ≥ 4 years (range, 4 to 12 years) and had handled 2,000 to 4,000 patient visits per year. These local experts explained the aim and procedures to the physicians and their staffs. Questionnaires were distributed

Results

Of the 8,000 distributed questionnaires, 6,223 forms (78%) were entered for analysis. The response rate varied among sites, as follows: 3 of 26 US sites, 40 to 50%; 2 of 14 European sites, 48% and 54%; all remaining sites, 70 to 98% (data available on request). The elimination of sites with a response rate of < 50% did not significantly alter the results and so were left in the final analysis. The major reason for a low response rate was a failure to distribute/return copies. The return rate

Discussion

This is the first large data set providing information collected by a standardized protocol on snoring, sleepiness, and other features associated with sleep apnea across many primary care sites. The results confirmed a widespread distribution of patients with a surprisingly high rate of reported frequent sleepiness and drowsy driving, behaviors that pose individual and societal risks. Approximately one third of patients reported symptoms and risk factors with a high likelihood for finding sleep

Appendix

The other members of the Sleep in Primary Care International Study Group are as follows: Jose Alvarez Sala, Madrid, Spain; Cherryl Carlucci, Stuart, FL; Martin Cohn, Naples, FL; Michael Coppola, Springfield, MA; Eugene C. Fletcher, Louisville, KY; James Mooney, Ashland, OH; Rainer Morawa, Kitzingen, Germany; Annette Neumann, Leipzig, Germany; Wolfgang Pirsig, Ulm, Germany; James O’Brien, Milton, MA; and Peter Werner, Wilmette, IL.

The authors thank these members for acting as tutors for the

ACKNOWLEDGMENTS

We thank the primary care physicians for their participation in the study. We acknowledge Ed Schuck, Alpha One Foundation, Wayzata, MN, for his continuous support to the Sleep in Primary Care International Study Group since 1995. We also thank Mansour Mustafa, MD, and Susan Redline, MD, MPH, for providing advice and internal review of the manuscript.

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  • Cited by (0)

    This research was supported in part by the Veterans Affairs Medical Service and by a Sleep Academic Award (HL97015). National Sleep Technologies Inc, Arnold, MD, provided logistic support in the Washington DC area, and 3M Inc, Minneapolis, MN, and 3M Medica GmbH, Neuss, Germany, provided an unrestricted grant to print the various forms of the Berlin questionnaire. The Berlin Questionnaire is held as a US copyright by iONSLEEP LLC (Shaker Heights, OH) and may be used for academic and research purposes without fee or license.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail:[email protected]).

    A list of other members of the Sleep in Primary Care International Study Group is located in the Appendix.

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