National patterns of physician management of sleep apnea and treatment among patients with hypertension
Rapoport, David M.
Ladapo, Joseph A.
AffiliationUniv Arizona, Dept Med
MetadataShow full item record
PublisherPUBLIC LIBRARY SCIENCE
CitationRobbins R, Seixas A, Jean-Louis G, Parthasarathy S, Rapoport DM, Ogedegbe G, et al. (2018) National patterns of physician management of sleep apnea and treatment among patients with hypertension. PLoS ONE 13(5): e0196981. https://doi.org/10.1371/journal.pone.0196981
Rights© 2018 Robbins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at firstname.lastname@example.org.
AbstractStudy objectives Sleep apnea is associated with hypertension, and treatment may improve outcomes. We examine national burden of sleep apnea, rates of sleep apnea treatment, and whether racial/ethnic disparities exist among patients with hypertension. Methods Data from the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), 2005-2012, were analyzed (N = 417,950). We identified hypertension patient visits where sleep apnea diagnosis or complaint was recorded. Primary outcome measures were sleep study, medication, or behavioral therapy (diet, weight loss, or exercise counseling). We used multivariate logistic regression to examine treatment by demographic/clinical factors. Results Among patients with hypertension, sleep apnea was identified in 11.2-per-1,000 visits. Overall, patients with hypertension and a sleep disorder were referred for sleep study in 14.4% of visits, prescribed sleep medication in 11.2% of visits, and offered behavioral therapy in 34.8% of visits. Adjusted analyses show behavioral therapy more likely to be provided to obese patients than normal/overweight (OR = 4.96, 95%CI[2.93-8.38]), but less likely to be provided to smokers than nonsmokers (OR = 0.54, 95%)/CI[0.32-0.93]). Non-Hispanic blacks were less likely to receive medications than non-Hispanic whites (OR = 0.19, 95% CI[0.06-0.65]). Conclusions In the U.S., sleep apnea were observed in a small proportion of hypertension visits, a population at high-risk for the disorder. One explanation for the low prevalence of sleep apnea observed in this patient population at high risk for the disorder is under-diagnosis of sleep related breathing disorders. Behavioral therapy was underutilized, and non-Hispanic Blacks were less likely to receive medications than non-Hispanic Whites.
NoteOpen access journal.
VersionFinal published version
SponsorsNational Heart, Lung, and Blood Institute [R25HL116378, K23 HL116787]; National Institutes of Health [R01 MD011544]; Robert Wood Johnson Foundation 
- Physician and patient factors associated with the prescribing of medications for sleep difficulties that are associated with high abuse potential or are expensive: an analysis of data from the National Ambulatory Medical Care Survey for 1996-2001.
- Authors: Rasu RS, Shenolikar RA, Nahata MC, Balkrishnan R
- Issue date: 2005 Dec
- Medication therapy in ambulatory medical care. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1992.
- Authors: Nelson CR, Knapp DE
- Issue date: 1997 Aug 8
- Recognition of Sleep Apnea Is Increasing. Analysis of Trends in Two Large, Representative Databases of Outpatient Practice.
- Authors: Namen AM, Chatterjee A, Huang KE, Feldman SR, Haponik EF
- Issue date: 2016 Nov
- Anxiety and unrecognized high blood pressure in U.S. ambulatory care settings: an analysis of the 2005 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.
- Authors: Player MS, Mainous AG 3rd, Carnemolla M
- Issue date: 2008
- Potential Health Implications of Medication Therapy Management Eligibility Criteria in the Patient Protection and Affordable Care Act Across Racial and Ethnic Groups.
- Authors: Wang J, Qiao Y, Shih YC, Jarrett-Jamison J, Spivey CA, Wan JY, White-Means SI, Dagogo-Jack S, Cushman WC, Chisholm-Burns M
- Issue date: 2015 Nov