Physician practices in the diagnostic evaluation of suspected Obstructive Sleep Apnea (OSA)
Purpose: To determine if physician training alters diagnostic testing for suspected OSA. Methods: Questionnaires were mailed to a random national sample of 2000 board-certified physicians from various specialties. Physicians were asked which diagnostic test they typically ordered first for suspected OSA. We used chi-square analysis to test for association between specialty (or sleep board certification) and diagnostic test ordered. Results: SL=Sleep Lab Polysomnogram (PSG); OXI=Overnight Pulse Oximetry; SPL=Split Night PSG (with CPAP titration); AMB=Ambulatory PSG MIS=Miscellaneous First test ordered for suspected OSA by specialty: SL AMB OXI SPL MIS Neurology 61% 2% 9% 20% 8% (n=89) Otolaryngology 51% 23% 7% 18% 1% (n=90) Primary Care 68% 11% 15% 6% 0% (n=62) Pulmonary 48% 4% 7% 38% 2% (n=130) (p<0.001 for differences between groups) By certification by the American Board of Sleep Medicine: Boarded 55% 4% 4% 33% 4% (n=171) Not Boarded 55% 13% 11% 19% 2% (n=249) (p<0.001 for differences between groups) Conclusions: Physician training impacts significantly on the diagnostic evaluation of OSA. Clinical Implications: Prospective studies are warranted to assess the cost-effectiveness and outcomes of these different diagnostic approaches.