0487 WHAT SYMPTOMS MOTIVATE FAMILY MEDICINE PATIENTS TO PURSUE SLEEP APNEA SCREENING?

Abstract

Introduction: Obstructive sleep apnea (OSA) is difficult to identify, and studies suggest that patients are under-referred for screening from primary care. Here we look at what happens when consecutive family medicine patients are offered sleep apnea assessment: What symptoms seem to guide patients to pursue assessment? How many unrecognized cases can we find? Methods: 295 adults over age 40 (174 women, 121 men) were recruited from two hospital family medicine clinics. None were previously assessed for sleep apnea. All completed questionnaires (Sleep Symptom Checklist (SSC), Sleep Questionnaire). Metabolic syndrome health data were collected from medical charts. All were offered an overnight polysomnography (PSG) study in a sleep laboratory. 171 (58%) completed the PSG study. Non-completers cited lack of interest (40%) and lack of time or desire to sleep away from home (18%). Completers and Non-Completers did not differ in mean age or gender ratio. Results: Completers had a very high rate of diagnosed OSA: 80%. On self-report, Completers reported greater severity of daytime symptoms (e.g., non-refreshed in the morning, difficulty with concentration) than Non-completers. Metabolic syndrome disease was present in both groups: 59% of Non-completers had at least one of hypertension, hyperlipidemia, diabetes, or obesity and 46% of Completers. The difference was not significant. No significant differences were found between Completers and Non-Completers on severity of insomnia, sleep disorder, or psychological symptoms. Conclusion: Family medicine patients over age 40 who were willing to complete an overnight PSG study differed in self-reported symptom severity from Non-completers primarily in daytime symptoms. Metabolic syndrome, which is strongly associated with OSA, was at least as frequent in the Non-completers as in Completers. Taken together, these data suggest that (1) Completers may be motivated by their negative daytime experience to pursue sleep testing and that (2) an important percentage of Non-completers likely have OSA.