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Comparative Study
. 2010 Sep;33(9):1255-60.
doi: 10.1093/sleep/33.9.1255.

Assessing the prioritization of primary care referrals for polysomnograms

J Daryl Thornton  1 , Kinnari Chandriani, Julia G Thornton, Sobia Farooq, Moayyed Moallem, Vidya Krishnan, Dennis Auckley
Affiliations
Comparative Study

Assessing the prioritization of primary care referrals for polysomnograms

J Daryl Thornton et al. Sleep. 2010 Sep.

Abstract

Study objective: The mortality attributed to obstructive sleep apnea (OSA) is comparable to that of breast cancer and colon cancer. We sought to determine if patients at high risk for OSA were less likely to be referred by their primary care physician for polysomnograms (PSG) than mammograms or endoscopies.

Design: Prospective cohort study; patients were recruited between January 2007 and April 2007.

Setting: Academic public hospital system

Patients: 395 patients waiting for family or internal medicine primary care appointments were administered the Berlin questionnaire. Chart abstraction or interview determined demographics; insurance and employment status; body mass index (BMI); comorbidities; and prior PSG, mammography, or endoscopy referrals.

Results: Mean BMI was 30 +/- 7.4 kg/m2; 187 (47%) patients had high-risk Berlin scores. Overall, 19% of patients with high-risk Berlin scores were referred for PSG, compared to 63% of those eligible for mammograms and 80% of those eligible for endoscopies. Women (OR = 2.9, P = 0.02), COPD (OR = 4.6, P = 0.03), high-risk Berlin scores (OR = 3.4, P = 0.009), and higher BMI (OR = 1.1, P < 0.001) were positively associated with PSG referrals. Privately insured patients were less likely to be referred than uninsured patients (OR = 0.3, P = 0.04). There was no significant difference in referrals among those with other forms of insurance. Race was not associated with PSG referrals.

Conclusion: In a public hospital, primary care patients were less likely to be referred for PSG compared to mammogram and endoscopy. Uninsured patients were more likely to be referred for PSG than those with private insurance. Further studies are needed to address the low PSG referral rates in high-risk populations.

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Figures

Figure 1A
Figure 1A
The percentage of all eligible female patients referred for obstructive sleep apnea, breast cancer, and colon cancer screening
Figure 1B
Figure 1B
The percentage of all eligible patients referred for obstructive sleep apnea, breast cancer, and colon cancer screening
See this image and copyright information in PMC

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