Approach to outpatient management of adult sleep apnea

To describe an approach to sleep apnea for family physicians based on a review of current practice limitations for Canadian family physicians, validated risk prediction tools, and ambulatory sleep apnea technologies.

Published epidemiologic studies focused on family practice management of sleep apnea, clinical practice guidelines, risk prediction tools for sleep apnea, randomized controlled treatment trials, and the author's community practice audit. Evidence was levels I, II, and III.

Sleep apnea is commonly encountered in family practice, but many family physicians are unfamiliar with sleep medicine. The pretest probability of sleep apnea can be accurately predicted using any one of several simple risk prediction tools. Screening for other common sleep disorders is important, especially when the pretest probability of sleep apnea is low to intermediate; one-third of sleep apnea patients have additional sleep disorders. The use of home-based rather than laboratory-based diagnostic testing and treatment titration is controversial, but the former setting is often used when referral access is limited.

There are several tools that allow family physicians to make accurate sleep apnea risk assessments. There is growing evidence to guide home- versus laboratory-based diagnosis and treatment of sleep apnea.