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    National patterns of physician management of sleep apnea and treatment among patients with hypertension

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    Author
    Robbins, Rebecca
    Seixas, Azizi
    Jean-Louis, Girardin
    Parthasarathy, Sairam
    Rapoport, David M.
    Ogedegbe, Gbenga
    Ladapo, Joseph A.
    Affiliation
    Univ Arizona, Dept Med
    Issue Date
    2018-05-23
    
    Metadata
    Show full item record
    Publisher
    PUBLIC LIBRARY SCIENCE
    Citation
    Robbins 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
    Journal
    PLOS ONE
    Rights
    © 2018 Robbins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.
    Collection Information
    This 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 repository@u.library.arizona.edu.
    Abstract
    Study 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.
    Note
    Open access journal.
    ISSN
    1932-6203
    PubMed ID
    29791455
    DOI
    10.1371/journal.pone.0196981
    Version
    Final published version
    Sponsors
    National Heart, Lung, and Blood Institute [R25HL116378, K23 HL116787]; National Institutes of Health [R01 MD011544]; Robert Wood Johnson Foundation [72426]
    Additional Links
    http://dx.plos.org/10.1371/journal.pone.0196981
    http://dx.plos.org/10.1371/journal.pone.0196981.t001
    http://dx.plos.org/10.1371/journal.pone.0196981.t002
    http://dx.plos.org/10.1371/journal.pone.0196981.t003
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0196981
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