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Prevalence of Symptoms and Risk of Sleep Apnea in Primary Care^*

Nikolaus C. Netzer, MD; Josef J. Hoegel, PhD; Daniel Loube, MD, FCCP; Cordula M. Netzer, MD; Birgit Hay, BS; Rudolfo Alvarez-Sala, MD, PhD and Kingman P. Strohl, MD, FCCP; for the Sleep in Primary Care International Study Group

^* From the The Center for Sleep Disorders Research (Drs. NC Netzer, CM Netzer, and Strohl), Case Western Reserve University, Cleveland, OH; Department of Biometry and Medical Documentation (Dr. Hoegel and Ms. Hay), University of Ulm, Ulm, Germany; Swedish Medical Center (Dr. Loube), Seattle, WA; and the Pulmonary Department (Dr. Alvarez-Sala), Hospital de la Paz, Autonomous University of Madrid, Madrid, Spain. A list of other members of the Sleep in Primary Care International Study Group is located in the ^Appendix.

Correspondence to: Kingman P. Strohl, MD, FCCP, 111j(w), Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, 10701 East Blvd, Cleveland, OH 44106; e-mail: KPSTROHL{at}aol.com

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.

Key Words: hypertension • obesity • questionnaire • sleep apnea • snoring

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