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Increased Physician-Reported Sleep Apnea^*

The National Ambulatory Medical Care Survey

^* From the Department of Respiratory, Critical Care and Sleep Medicine (Dr. Namen), Baptist Medical Center, Jacksonville, FL; Departments of Internal Medicine, Division of Pulmonary and Critical Care Medicine (Dr. Dunagan), Dermatology (Dr. Fleischer), Library Science (Ms. Tillet and Ms. Barnet), and Psychiatry (Dr. McCall), Wake Forest University School of Medicine, Winston-Salem, NC; and Division of Pulmonary and Critical Care Medicine (Dr. Haponik), Johns Hopkins University School of Medicine, Baltimore, MD.

Correspondence to: W. Vaughn McCall, MD, MS, Department of Psychiatry and Behavioral Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157; e-mail: vmccall{at}wfubmc.edu

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.

Key Words: medical literature • sleep apnea • specialist

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