Prevalence of symptoms and risk of sleep apnea in primary care

Background: To obtain prevalence estimates for key symptoms and features that can indicate the presence of obstructive sleep apnea (OSA) in a broad range of primary care settings. Design: Cross-sectional survey. Setting: Forty offices and clinics in the United States, Germany, and Spain. Participants: Consecutive patients who were > 15 years of age, regardless of the reason for the visit. Measurements: We collected demographic information, prevalence of self-reported chronic snoring, sleepiness, obesity (body mass index [BMI] > 30), hypertension, and calculation of OSA risk, and we also compared results between the United States and Europe. Results: There was a 78% return rate for 8,000 surveys (mean age, 51 years; age range, 15 to 98 years; 52% women). One third of participants (32%) had a high pretest probability for OSA, with a higher rate in the United States (35.8% of 3,915 participants) than in Europe (26.3% of 2,308 participants; p < 0.001; age-matched and sex-adjusted odds ratio [OR], 1.37; 95% confidence interval [CI], 1.16 to 1.61). Sleepiness (32.4% vs 11.8%, respectively; p < 0.001) followed by obesity and/or hypertension (44.8% vs 37.1%, respectively; p < 0.01) contributed to the OSA risk difference between participants in the United States and Europe, as frequent snoring and breathing pauses were similarly reported (44%). A high pretest probability for OSA was more often present in men than in women (37.9% vs 27.8%, respectively; p < 0.005; OR, 1.96; CI, 1.59 to 2.88) and in those that were obese (ie, BMI, greater than or equal to 30 kg/m(2)), a condition that is generally more common in the US population than in the European population. (27.9% vs 17.2%, respectively; p < 0.01). Conclusions: Primary care physicians in the United States and Europe mill encounter a high demand for services to confirm or manage sleep apnea, sleepiness, and obesity.