National patterns of physician management of sleep apnea and treatment among patients with hypertension
N =
National patterns of physician management of sleep apnea and treatment among patients with hypertension
Rebecca Robbins 0 2 3
Azizi Seixas 0 2 3
Girardin Jean-Louis 0 2 3
Sairam Parthasarathy 0 1 2
David M. Rapoport 0 2
Gbenga Ogedegbe 0 2 3
Joseph A. Ladapo 0 2
0 Funding: Funded by National Heart, Lung, and Blood Institute R25HL116378 Girardin Jean-Louis National Heart, Lung, and Blood Institute K23 HL116787 Joseph A Ladapo, National Institutes of Health R01 MD011544 Joseph A Ladapo , Robert
1 Department of Medicine, University of Arizona, Tuscon, Arizona, United States of America, 3 Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America, 4 Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA , Los Angeles, California , United States of America
2 Editor: Andrea Romigi, University of Rome Tor Vergata , ITALY
3 Department of Population Health, NYU School of Medicine , New York, New York , United States of America
Study objectives
-
Data Availability Statement: All data files are
available from publicly available websites
accessible through the CDC website: https://www.
cdc.gov/nchs/ahcd/datasets_documentation_
related.htm.
Methods
Results
Wood Johnson Foundation 72426 Joseph A
Ladapo.
Competing interests: The authors have declared
that no competing interests exist.
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.
Introduction
Sleep apnea is common among patients with cardiovascular disease (CVD),[
1
] particularly
hypertension.[2±8] [
9
] This can be explained in part by the observation that hypertension and
sleep apnea share common pathophysiological risk factors that exacerbate both conditions.
[
10
] Sleep apnea is a treatable sleep disorder.[
11
] Unfortunately, while others have called for
increased attention to diagnosing and treating sleep apnea among hypertension patients,[
12
]
we know little about physician management of hypertensive patients presenting with sleep
apnea in national samples.
There is growing epidemiological evidence supporting a relationship between sleep apnea
and hypertension. Sleep apnea is associated with increased mortality and both hypertension
and pulmonary hypertension, in addition to coronary artery disease (CAD), cardiac
arrhythmias, congestive heart failure (CHF), and stroke.[
11
] Previous analysis utilizing the National
Ambulatory Medical Care Survey has examined characteristics of sleep-related medical visits
in the general population (e.g., prevalence of sleep difficulty, and physician management),[
13
]
yet we know little about trends pertaining to sleep apnea prevalence or treatment among
higher-risk patients with hypertension.
In addition to the link between hypertension and sleep, evidence suggests sleep apnea is
undertreated in the general population.[
14
] According to some estimates, sleep apnea affects
between 9 and 24 percent of adults in the US,[
10,15
] but only 2 percent report a diagnosis.[16]
Particularly concerning are even lower rates of diagnosis among minority populations who
suffer a disproportionately higher burden of hypertension[
17
] and sleep apnea.[
18,19
] Blacks
in particular are at greater risk of hypertension,[17] disrupted sleep,[
19
] and sleep apnea[
18
]
than other racial or ethnic groups. We know little about how sleep apnea diagnosis or
physician management approaches differ across racial or ethnic groups with cardiovascular risk
factors.
Clinical guidelines for the treatment of sleep apnea most often includes a sleep study, and
treatment using continuous positive airway pressure (CPAP).[
20
] Meta-analysis shows an
association between use of CPAP in the treatment of OSA and a modest reduction in blood
pressure.[
21
] Other, behavioral and lifestyle treatments that have been explored for the
treatment of OSA. Meta-analysis has found behavioral therapy, such as weight loss, to be effective
for reduction in OSA parameters.[
22
] We examine sleep apnea, as reported by patients or
diagnosed by physicians, and physician management of sleep apnea, specifically, provision of a
sleep study and behavioral treatment and therapy (e.g., weight loss, exercise) among
individuals with hypertension. We also examine physician provision of medication to patients with
sleep apnea, because some physicians may use sedative agents as a short-term strategy to
improve compliance with CPAP[23±25] or prescribe them to patients with comorbid
psychiatric illness,[
26
] though the (...truncated)