How are automatic positive airway pressure and related devices prescribed by sleep physicians? A web-based survey

Abstract

Study objectives: The main purpose of this study was to characterize the practices of sleep physicians prescribing positive airway pressure (PAP) therapy to patients with sleep-disordered breathing. The main outcome measures were to determine the indications for initiation of PAP therapy, the type of PAP devices prescribed, and the interfaces that were commonly used and to assess the physicians' familiarity with the newer PAP devices.

Design and setting: An anonymous web-based survey with 20 questions aimed at determining point-prevalence estimates of physician practices and physician knowledge.

Patients: None.

Interventions: None.

Measurements and results: 196 physician responses (24% response rate) were analyzed. Sleep physicians reported that obstructive sleep apnea was the most common diagnosis following sleep studies, but none reported central sleep apnea as a primary diagnosis. Physicians' prescription practices for PAP therapy and their perceptions of indications and contraindications of devices varied widely. Thirty percent of sleep physicians did not prescribe auto-PAP devices, and such devices constituted only 4% of all PAP devices prescribed. While many physicians took measures to help improve compliance--such as prescribing heated humidifiers (67%)--many did not insist on compliance monitoring (49%). Physicians who interpreted more than 20 sleep studies per month were more knowledgeable regarding auto-PAP devices and were more likely to prescribe such devices (P < .05).

Conclusions: Sleep physicians' practices and perceptions in prescribing PAP therapy varied widely, although the indication for prescribing PAP therapy was homogenous.