DIAGNOSIS AND TREATMENT OF SLEEP-APNEA WITHIN THE COMMUNITY - THE WALLA-WALLA PROJECT

Background: Patients with sleep disorders are common in primary care, yet most physicians lack training in the diagnosis and treatment of su ch patients. Objectives: To enhance recognition of sleep disorders by community physicians and transfer the diagnostic testing and care of s uch patients from tertiary care centers to the local community. To pre sent our polysomnogram experience relevant to sleep apnea. Methods: Sl eep disorders specialists provided a community with education, diagnos tic equipment, and ongoing support as sleep disorders expertise was es tablished locally. Outcomes for a 2-year period were assessed by chart review, patient questionnaire, tabulation of polysomnographic data, a nd comparison with published reports from specialized centers. Results : Referral for sleep testing increased by almost 8-fold in patients at the Walla Walla Clinic in Walla Walla, Wash, from 0.27% (2 of 752 cas es reviewed) to 2.1% (294 of 14330 internal medicine patients). Data w ere collected from all community physicians for a 2-year period on 360 new patients who underwent polysomnogram testing. This resulted in th e diagnosis of sleep-related breathing disorders in 81% and periodic l eg movements of sleep in 18%. Nasal continuous positive airway pressur e treatment was given to 228 patients (average baseline apnea index of 19.1), representing a higher volume of patients than at many traditio nal sleep centers, yet compliance with continuous positive airway pres sure was comparable. Conclusions: Sleep apnea is significantly underre cognized by primary care physicians. As a result of the intervention, local sleep expertise was established and large numbers of patients we re discovered and treated in the community. Thus, a significant public health problem is identified and a solution established.