The role of the primary care physician in recognizing obstructive sleep apnea.

Abstract

OBSTRUCTIVE sleep apnea (OSA) is a common disorder among middle-aged adults.^1,2 It occurs in 2% to 4% of this population and is more common in the elderly. However, OSA is a recently described disorder for which most primary care physicians do not have formal training. As managed care has a growing influence on the practice of medicine, primary care physicians may play a bigger role in screening for OSA. Prior to March 1994, the largest regional staff model health maintenance organization (HMO) restricted referrals for a sleep study to subspecialists in pulmonology, otorhinolaryngology, or neurology. On March 28, 1994, the HMO changed this policy. Primary care physicians, including internal medicine and family practice physicians were sent a memo instructing them to directly order sleep studies. They were provided with a work sheet to aid them in asking the appropriate questions to identify OSA. These work sheets were also placed in the office area where the physicians worked.