Referral Patterns and Positive Airway Pressure Adherence upon Diagnosis of Obstructive Sleep Apnea

Abstract

Objective: Obstructive sleep apnea (OSA) is a serious medical condition that adds to patient morbidity and mortality. Treatment with positive airway pressure (PAP) is the standard of care, but many patients refuse or do not tolerate PAP. Little is known about the subsequent management of these patients. We sought to understand what types of treatment, if any, adult patients with OSA receive who either fail or refuse PAP therapy within our institution.

Study design: Retrospective chart review.

Setting: Academic hospital.

Subjects: All adult patients undergoing polysomnogram during the months of March and April 2010 (n = 1174) who were diagnosed with OSA.

Methods: The electronic medical record was reviewed to determine the subsequent management of patients with a diagnosis of OSA, including tolerance or failure of PAP and referral to specialists upon intolerance.

Results: Of 1174 patients, 616 met inclusion criteria. Ultimately, 260 (42%) had documented adherence to PAP. Of 241 untreated patients, 84 patients (35%) were referred for further attempts at management of diagnosed OSA. Nearly half of patients with diagnosed OSA did not have continued treatment or referral.

Conclusion: To our knowledge, this is the first study to define the subsequent management of patients who have failed or refused PAP. Despite the known sequelae of OSA, clinicians are not treating a significant percentage of patients with diagnosed OSA. Those who fail to tolerate PAP therapy are unlikely to be referred for additional treatment. Therapies other than PAP may be warranted in this population.

Keywords: adherence; failure; obstructive sleep apnea; positive airway pressure; sleep surgery.