American College of Physicians Internal Medicine Meeting

American College of Physicians Internal Medicine Meeting

April 12, 2019
2 min read

Sleep apnea common, but underdiagnosed: How to spot the disease

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PHILADELPHIA — While obstructive sleep apnea often goes undiagnosed, known risk factors, symptoms and assessment tools can help primary care physicians identify the disease, according to a presentation at the ACP Internal Medicine Meeting.

“The prevalence of OSA in American adults is quite high,” Jeanne Wallace, MD, MPH, health sciences professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, said during her presentation.

More than 25 million adults in the United States are believed to have moderate to severe OSA, which is comparable to the prevalence of diabetes and even higher than asthma, she said. However, about 75% of severe cases are undiagnosed, she said.

Recognizing and treating OSA is critical, because when it is left untreated, it is disabling; increases the risk for certain medical complications, including stroke, arrythmias, NAFLD, obesity and CV mortality; and increases health care utilization costs, according to Wallace.

While obstructive sleep apnea often goes undiagnosed, known risk factors, symptoms and assessment tools can help primary care physicians identify the disease.
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Identifying OSA

A PCP or sleep medicine specialist should do an initial clinical assessment of patients with suspected OSA, she said.

Common risk factors of OSA include overweight, male, large neck, enlarged tonsils, craniofacial structure, family history, stroke, endocrinopathy and hypertension. Symptoms of OSA to be aware of include excessive daytime sleepiness, loud snoring, witnessed apneas, restless sleep and awakenings, nocturia, unrefreshing sleep, nocturnal/early morning chest pain, sexual dysfunction, morning headache, cognitive problems and depression.

Physicians should use an assessment tool such as STOP BANG to screen for OSA, she said. STOP BANG considers snoring, tiredness, observed stop breathing in sleep, high BP, BMI over 35 kg/m², age over 50 years, neck circumference larger than 40 cm and male gender.

Patients identified as having OSA should then receive testing in a sleep center, education and treatment and long-term follow-up, Wallace said.

Treating OSA

The leading treatment for OSA is continuous positive airway pressure (CPAP), she said. She noted that when treating moderate-to-severe OSA with CPAP, high health care utilization and costs are reversed, CV events are reduced, mortality risk is diminished and well-being, quality of life and daytime function are improved.

“Optimal long-term management requires continual monitoring of adherence and efficacy by CPAP trackers,” Wallace said.

The main roles of the PCP are to identify, assess, refer and follow-up with patients with OSA, while the roles of the sleep medicine specialist are to assess, test, initiate and monitor treatment and follow-up, she said.

“Patients are best served by long-term collaboration between PCPs and sleep medicine specialists,” Wallace emphasized. – by Alaina Tedesco



Wallace, J. Obstructive sleep apnea: What’s new for the internist? Presented at: ACP Internal Medicine Annual Meeting. April 11-13, 2019; Philadelphia.

Disclosure: Wallace reports no relevant financial disclosures.