Variation in physician threshold to treat Obstructive Sleep Apnea (OSA)
Purpose: To determine the factors which influence physician decision making in regard to the threshold for treatment in OSA. Methods: Questionnaires were mailed to a random national sample of 2000 board-certified physicians from various specialties. Physicians were asked what threshold apnea-hypopnea index (AHI) they used to treat most patients with OSA. We used a chi-square analysis to analyze for differences in AHI threshold for treatment. Results: Only 9/160 (6%) of physicians who were certified by the American Board of Sleep Medicine chose an AHI>30 as the threshold for treatment as opposed to 35/201 (17%) of physicians not board certified in sleep medicine (p<0.001). Of physicians who reported seeing 5 or more patients/ month with OSA, 18/243 (7.4%) reported using an AHI>30 as the threshold for treatment versus 26/118 (22%) of physicians who saw less than 5 patients per month with OSA (p<0.001). Threshold for treatment was not different between physicians in academic medicine versus those in private practice. There was also no correlation between percentage of managed care patients in the practice and AHI threshold for treatment. Conclusions: Physicians with more expertise in sleep medicine appear to be more likely to treat OSA patients with an AHI <30. Clinical Implications: Prospective studies are warranted to assess the cost-effectiveness and outcomes of these different treatment thresholds in OSA.