Assessing the Adequacy of Obstructive Sleep Apnea Diagnosis for High-Risk Patients in Primary Care

Benjamin Arsic; Kristina Zebic; Aamna Sajid; Neha Bhave; Karla D. Passalacqua; Denise White-Perkins; Lois Lamerato; Della Rees; Katarzyna Budzynska

doi:10.3122/jabfm.2022.02.210296

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Table 1.

Demographic Information of Patients in Primary Care Clinics Including Total Patients in the Sample and Those Who Were at High Risk of Obstructive Sleep Apnea

	All Patients N (%) (n = 30,022)	High-Risk Patients N (%) (n = 4,911)
Race/ethnicity
African American	17,787 (59%)	3,252 (66.2)
Other	12,235 (41%)	1,659 (33.8)
Body mass index, kg/m²
18.5 to 24.9	394 (1.35%)	18 (0.37)
25.0 to 29.9	6,556 (22.5%)	478 (9.8)
30.0 to 39.9	10,059 (34.6%)	2,228 (45.7)
> 40	3,379 (11.6%)	1,186 (24.3)
Risk Factors
Body mass index, kg/m²
35 and under	22,996 (76.6%)	2,264 (46.1)
> 35	7,026 (23.4%)	2,647 (53.9)
Age
≤ 50 years	14,453 (48.1%)	313 (6.4)
> 50 years	15,569 (51.9%)	4,598 (93.6)
Sex
Male	10,191 (34%)	3,397 (69.2)
Female	19,831 (66.1%)	1,514 (30.8)
Hypertension
Yes	9,802 (32.6%)	4,602 (93.7)
No	20,220 (67.4%)	309 (6.3)
Urban clinic	18,408 (61.3%)	3,189 (64.9)
Suburban clinic	11,614 (38.7%)	1,722 (35.1)

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Table 2.

Chi-Square Analysis of Association between Characteristics of Patients at High Risk for Obstructive Sleep Apnea and Clinical Assessment for Obstructive Sleep Apnea

	OSA not assessed N (%)^*	OSA assessed N (%)^*	P value^{^†}
Total (n = 4,911)	3,387 (69.0)	1,524 (31.0)
Sex			< 0.01
Female	962 (63.4)	552 (36.6)
Male	2,425 (71.4)	972 (28.6)
Age			< 0.01
≤ 50 years	151 (48.2)	162 (51.8)
> 50 years	3,236 (70.4)	1,362 (29.6)
Clinic location^{^‡}			0.49
Urban	2,169 (68.0)	1,020 (32.0)
Suburban	1,218 (70.7)	504 (29.3)
Body mass index, kg/m²			< 0.01
≤ 35	1,865 (82.4)	399 (17.6)
> 35	1,522 (57.5)	1,125 (42.5)
Race/Ethnicity			0.05
African American	2,213 (68.1)	1,039 (31.9)
Not African American^{^§}	1,174 (70.8)	485 (29.2)
Hypertension			< 0.01
No	161 (52.1)	148 (47.9)
Yes	3,226 (70.1)	1,376 (29.9)

Abbreviation: OSA, obstructive sleep apnea.
↵* Percentages are row percentages (number/[OSA not assessed + OSA assessed]).
↵† Calculated per χ² test.
↵‡ Urban clinic is Detroit Northwest and Harbortown; Suburban clinic in Troy and Commerce Township.
↵§ Not African American includes Asian, Hispanic, and White ethnicity reported in medical record.

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Table 3.

Logistic Regression Analysis of Variables Associated with Screening for OSA in the Total Patient Population and in High-Risk Patients

	OSA High-Risk Patients N = 4,911
	Odds Ratio	95% CI	P value
African American ethnicity	1.00	0.83–1.20	0.970
Suburban medical center	0.98	0.82–1.18	0.860
Age > 50 years	0.99	0.74–1.31	0.926
Body mass index > 35 kg/m²	4.96	4.04–6.09	<0.001
Hypertension	1.15	0.87–1.53	0.324
Male sex	1.84	1.51–2.26	<0.001

Abbreviations: OSA, obstructive sleep apnea; CI, confidence interval.

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Table 4.

Reasons for Referrals to Sleep Study Based on a Random Chart Review of the 1,524 Patients Who Were Screened for Obstructive Sleep Apnea

Reason for Referral	N (%) of Patients (n = 200)^*
Snoring	58 (29%)
Existing obstructive sleep apnea diagnosis follow-up	38 (19%)
Daytime sleepiness	32 (16%)
Elevated body mass index	14 (7%)
Fatigue	16 (8%)
Hypertension	14 (7%)
Other/unknown	28 (14%)