Chest. 2003;124:1406-1414. October 2003 ©
Nikolaus C. Netzer, MD; Josef J. Hoegel, PhD; Daniel Loube, MD, FCCP; Cordula M. Netzer, MD; Birgit Hay, BS; Rudolfo Alvarez-Sala, MD, PhD and Kingman P. Strohl, MD, FCCP; for the Sleep in Primary Care International Study Group. Correspondence to Kingman P. Strohl, MD KPSTROHL@aol.com
Sleep apnea, sleepiness and obesity common in primary care in US and Europe
To obtain prevalence estimates for key symptoms and features that can indicate the presence of obstructive sleep apnea (OSA) in a broad range of primary care settings, researchers undertook a cross-sectional survey of 40 offices and clinics in the United States, Germany, and Spain of consecutive patients who were > 15 years of age, regardless of the reason for the visit and collected demographic information, prevalence of self-reported chronic snoring, sleepiness, obesity (BMI > 30), hypertension, and calculation of OSA risk, and compared results between the United States and Europe. There was a 78% return rate for 8,000 surveys (mean age, 51 years; 52% women).
They found that one third of participants (32%) had a high pretest probability for OSA, with a higher rate in the United States (35.8% of 3,915 participants) than in Europe (26.3% of 2,308 participants; p < 0.001; age-matched and sex-adjusted odds ratio [OR], 1.37). Sleepiness (32.4% vs 11.8%, respectively; p < 0.001) followed by obesity and/or hypertension (44.8% vs 37.1%, respectively; p < 0.01) contributed to the OSA risk difference between participants in the United States and Europe, as frequent snoring and breathing pauses were similarly reported (44%). A high pretest probability for OSA was more often present in men than in women (37.9% vs 27.8%, respectively; p < 0.005; OR, 1.96) and in those that were obese (ie, BMI 30 or more), a condition that is generally more common in the US population than in the European population (27.9% vs 17.2%, respectively; p < 0.01).
The researchers concluded: "Primary care physicians in the United States
and Europe will encounter a high demand for services to confirm or manage sleep
apnea, sleepiness, and obesity."