Sleep Breath 2004; 8(3): 111-124
DOI: 10.1055/s-2004-834481
ORIGINAL ARTICLE

Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Primary‐Care Practitioners and Sleep Specialists in the Treatment of Obstructive Sleep Apnea

Steven M. Scharf1 , Jennifer DeMore1 , Talia Landau1 , Patricia Smale1
  • 1Sleep Disorders Center, Division of Pulmonary and Critical Care, University of Maryland, Baltimore, Maryland
Further Information

Publication History

Publication Date:
24 September 2004 (online)

We wished to determine if being treated for sleep apnea by a sleep specialist increased patient awareness or long-term continuous positive airway pressure (CPAP) compliance. We performed a retrospective telephone survey and laboratory chart review in patients with a diagnosis of sleep apnea evaluated either at a laboratory in which only sleep specialists can order polysomnography (University Specialty Hospital, noted as USH) or at a laboratory serving the medical community at large (Kernan Hospital, noted as K). Both laboratories are under the same medical director, use the same policies and procedures, equipment, and technician pool. One hundred three patients participated in the survey (approximately 37% of those contacted), 59 from USH and 44 from K. The groups were comparable in terms of demographics, presenting complaints, and apnea severity. In patients treated by sleep specialists, awareness of the disease process was greater and the evaluation was timelier than in patients treated by generalists. However, there was no difference between the groups' long-term self-reported CPAP acceptance or compliance. The most robust predictor of continued CPAP use was the patient's self-report of feeling better.

REFERENCES

  • 1 Young T, Peppard P E, Gottlieb D J. Epidemiology of obstructive sleep apnea: a population health perspective.  Am J Resp Crit Care Med. 2002;  165 1217-1239
  • 2 Bassiri A, Guilleminault C. Clinical features and evaluation of obstructive sleep apnea-hypopnea syndrome. In: Kryger MH, Roth T, Dement WC Principles and Practice of Sleep Medicine. 3rd ed Philadelphia, PA; WB Saunders Co 2000: 869-878
  • 3 Nieto F J, Young T B, Lind B K et al.. Association of sleep-disordered breathing, sleep apnea and hypertension in a large community-based study. Sleep Heart Health Study.  JAMA. 2000;  283 1829-1836
  • 4 Jenkinson C, Davies R J, Mullins R, Stradling J R. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized prospective parallel trial.  Lancet. 1999;  353 2100-2105
  • 5 Sullivan C E, Issa F G, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares.  Lancet. 1981;  1 862-865
  • 6 Engleman H M, Kinshott R N, Wraith P K, Mackey T W, Deary I J, Douglas N J. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome.  Am J Respir Crit Care Med. 1999;  159 461-467
  • 7 Kribbs N B, Pack A I, Kline L R et al.. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea.  Am Rev Resp Dis. 1993;  147 887-895
  • 8 Weaver T E, Kribbs N B, Pack A I et al.. Night-to-night variability in CPAP use over the first three months of treatment.  Sleep. 1997;  20 278-283
  • 9 McArdle N, Devereux G, Heidarnejad H, Engelman H M, Mackay T W, Douglas N J. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome.  Am J Respir Crit Care Med. 1999;  159 1108-1114
  • 10 Pepin J L, Krieger J, Rodenstein D et al.. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients.  Am J Respir Crit Care Med. 1999;  160 1124-1129
  • 11 Popescu G, Latham M, Allgar V, Elliott M W. Continuous positive airway pressure for sleep apnoea/hypopnoea syndrome: usefulness of a 2-week trial to identify factors associated with long-term use.  Thorax. 2001;  56 727-733
  • 12 Hui D S, Chan J K, Choy D K et al.. Effects of augmented continuous positive airway pressure education and support on compliance and outcome in a Chinese population.  Chest. 2000;  117 1410-1416
  • 13 Hoy C J, Vennelle M, Kingshott R N, Engelman H M, Douglas N J. Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome?.  Am J Respir Crit Care Med. 1999;  159 1096-1100
  • 14 Likar L L, Panciera T M, Erickson A D, Rounds S. Group education sessions and compliance with nasal CPAP therapy.  Chest. 1997;  111 1273-1277
  • 15 Chervin R D, Theut S, Bassetti C, Aldrich M S. Compliance with nasal CPAP can be improved by simple interventions.  Sleep. 1997;  20 284-289
  • 16 Netzer N C, Stoohs R A, Netzer C M, Clark K, Strohl K P. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.  Ann Intern Med. 1999;  131 485-491
  • 17 Netzer N C, Hoegel J J, Loube D et al.. Prevalence of symptoms and risk of sleep apnea in primary care.  Chest. 2003;  124 1406-1414
  • 18 Namen A M, Dunagan D P, Fleischer A et al.. Increased physician-reported sleep apnea: the National Ambulatory Medical Care Survey.  Chest. 2002;  121 1741-1747
  • 19 Kramer N R, Cook T E, Carlisle C C, Corwin R W, Millman R P. The role of the primary care physician in recognizing obstructive sleep apnea.  Arch Intern Med. 1999;  159 965-968
  • 20 Haponik E F, Frye A W, Richards B et al.. Sleep history is neglected diagnostic information: challenges for primary care physicians.  J Gen Intern Med. 1996;  11 759-761
  • 21 Chung S A, Jairam S, Hussain M R, Shapiro C M. Knowledge of sleep apnea in a sample grouping of primary care physicians.  Sleep Breath. 2001;  5 115-121
  • 22 BaHammam A S. Knowledge and attitude of primary health care physicians towards sleep disorders.  Saudi Med J. 2000;  21 1164-1167
  • 23 Rosen R C, Rosekind M, Rosevear C, Cole W E, Dement W C. Physician education in sleep and sleep disorders: a national survey of U.S. medical schools.  Sleep. 1993;  16 249-254
  • 24 Multz A S, Chalfin D B, Samson I M et al.. A “closed” medical intensive care unit (MICU) improves resource utilization when compared to an “open” MICU.  Am J Respir Crit Care Med. 1998;  157 1468-1473
  • 25 Chesson A L, Ferber R A, Fry J M et al.. Practice parameters for the indications for polysomnography and related procedures. Polsomnography Task Force, American Sleep Disorders Association Standards of Practice Committee.  Sleep. 1997;  20 406-422
  • 26 Carskadan M A, Rechtschaffen A. Monitoring and staging human sleep. In: Kryger MH, Roth T, Dement WC Principles and Practice of Sleep Medicine. 3rd ed Philadelphia, PA; WB Saunders Co 2000: 1197-1215
  • 27 Rechtshaffen A, Kales A A Manual of Standardized Terminology: Techniques and Scoring System for Sleep Stages of Human Subjects. Bethesda, MD; US Department of Health, Education and Welfare. Public Health Service-National Institutes of Health. Neurological Information Network 1968
  • 28 Krieger J. Long-term compliance with nasal continuous positive airway pressure (CPAP) in obstructive sleep apnea patients and non-apneic snorers.  Sleep. 1992;  15 S42-S46
  • 29 Sin D D, Mayers I, Man G C, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea-a population-based study.  Chest. 2002;  121 430-435
  • 30 Engleman H M, Wild M R. Improving CPAP use by patients with the sleep apneoa-hypopnoea syndrome (SAHS).  Sleep Med Rev. 2003;  7 81-89

Steven M ScharfM.D. Ph.D. 

Division of Pulmonary and Critical Care, University of Maryland

685 West Baltimore St., MSTF 800

Baltimore, MD 21209

Email: sscharf@medicine.umaryland.edu