Variability in Physical Exam Documentation for Obstructive Sleep Apnea

This study evaluates variability in obstructive sleep apnea (OSA) physical exam templates, contrasts documentation between institutional settings, and identifies inter-specialty differences in documentation.

Cross-sectional analysis was performed using the Epic Community Library, a shared database of user-created documentation templates from institutions using the Epic electronic medical record system. Physical exam templates assessing sleep apnea were identified and evaluated against a checklist of 25 key physical exam characteristics from a clinical guideline.

Of 6621 templates from 478 institutions, 579 relevant templates were identified. The most frequently included features were vital signs (89.1%), tonsil size (69.5%), and septal deviation (60.2%). The least frequently recorded features were waist-hip ratio (0.8%), hyomental distance (1.6%), and Cottle maneuver (1.6%). The median template included only 7 out of our 25 key features, with an IQR of 5. Body mass index (BMI) was documented in 36.7% of exams. Of the templates from academic centers, 63% were unique compared to 14% from community centers and 27% from health networks. Otolaryngology templates documented nasal cavity and nasopharyngeal features and specialized airway techniques significantly more frequently than sleep medicine, pulmonology, and unspecified templates. In contrast, sleep medicine and pulmonology documented neck circumference more often than otolaryngology, and sleep medicine recorded Mallampati scores more frequently.

Significant variability exists in OSA physical exam documentation across institutions and specialties. This may contribute to disparities in patient evaluation and treatment. Standardized OSA physical exam templates could provide a more consistent and comprehensive anatomic exam, facilitate subspecialty communication, and support more accurate patient treatment selections.

Level 3.