Should testing for obstructive sleep apnea be offered routinely to older family medicine patients? A prospective cohort study

ABSTRACT

In our previous studies, we offered older family medicine patients testing for obstructive sleep apnea (OSA) and discovered that 80% of patients who accepted, were later diagnosed with unsuspected OSA. In the present study, we followed such patients for 3 years of usual treatment. The goals were to (1) observe whether wider testing for OSA would increase case recognition and treatment uptake; (2) identify symptom and health characteristics associated with diagnosis and treatment efficacy. 101 women and 75 men (>45 years) recruited from family medicine clinics completed questionnaires, polysomnography and consented to chart review (Time 1). Participants with OSA were offered treatment and follow-up with a sleep medicine specialist. All were re-evaluated after 3 years (Time 2). At Time 1, 93% of participants received a diagnosis of OSA. Of these, 53 initiated treatment (46 PAP therapy); at Time 2, 24 PAP users met criteria for adherence. PAP-adherent participants had worse OSA and worse reported symptoms at Time 1 than non-adherent participants. At Time 2, PAP-adherent participants improved on insomnia and daytime symptoms compared to non-adherent participants who showed no change. Adherent and non-adherent participants showed no difference in health indices at Time 1 and no change at three-year follow-up. Benefits of treatment included improvements in co-morbid insomnia and daytime functioning; however, offering wider testing for OSA to older, family medicine patients yielded a high rate of diagnosis but low treatment adoption and adherence. Therefore, a cost-effective strategy would identify and support those likely to adopt and adhere to treatment.

KEYWORDS:

• Family practice
• case finding
• sleep apnea
• adherence
• treatment outcome

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics

The study was approved by the McGill University Institutional Research Board, the Jewish General Hospital’s REC and the St. Mary’s Hospital’s Research Ethics Board in Montreal.

Additional information

Funding

The study was funded by the Canadian Institutes of Health Research (CIHR), grant number: MOP106451.