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

Rebecca Robbins, Azizi Seixas, Girardin Jean-Louis, Sairam Parthasarathy, David M. Rapoport, Olugbenga Ogedegbe, Joseph A. Ladapo

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere0196981
JournalPLoS One
Volume13
Issue number5
DOIs
StatePublished - May 1 2018

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Patient treatment
sleep apnea
Sleep Apnea Syndromes
physicians
hypertension
Hypertension
Physicians
sleep
drug therapy
Sleep
Health Care Surveys
therapeutics
Therapeutics
Reducing Diet
diet therapy
counseling
national surveys
Health care
breathing
Counseling

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Robbins, R., Seixas, A., Jean-Louis, G., Parthasarathy, S., Rapoport, D. M., Ogedegbe, O., & Ladapo, J. A. (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

National patterns of physician management of sleep apnea and treatment among patients with hypertension. / Robbins, Rebecca; Seixas, Azizi; Jean-Louis, Girardin; Parthasarathy, Sairam; Rapoport, David M.; Ogedegbe, Olugbenga; Ladapo, Joseph A.

In: PLoS One, Vol. 13, No. 5, e0196981, 01.05.2018.

Research output: Contribution to journalArticle

Robbins, R, Seixas, A, Jean-Louis, G, Parthasarathy, S, Rapoport, DM, Ogedegbe, O & Ladapo, JA 2018, 'National patterns of physician management of sleep apnea and treatment among patients with hypertension', PLoS One, vol. 13, no. 5, e0196981. https://doi.org/10.1371/journal.pone.0196981
Robbins, Rebecca ; Seixas, Azizi ; Jean-Louis, Girardin ; Parthasarathy, Sairam ; Rapoport, David M. ; Ogedegbe, Olugbenga ; Ladapo, Joseph A. / National patterns of physician management of sleep apnea and treatment among patients with hypertension. In: PLoS One. 2018 ; Vol. 13, No. 5.
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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.",
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