Factors Associated with Obstructive Sleep Apnea Evaluation in At-Risk Patients Generally and in the Perianesthesia Setting Specifically.

다국어 초록 (Multilingual Abstract)

Background/Purpose:Obstructive sleep apnea (OSA) is a highly prevalent yet underdiagnosed sleep-related breathing disorder. While studies have been conducted to examine factors associated with OSA care-seeking in at-risk individuals, it is unclear which factors are most influential. Further, these factors have not been explored in at-risk patients identified in the perianesthesia setting, in spite of this care specialty’s provision of routine OSA screening. We aimed to address these gaps by reviewing current literature on factors associated with OSA evaluation overall, and in patients identified as at-risk for OSA in the perianesthesia setting, examining associations between OSA care-seeking behavior and health related factors overall, and by age, sex, and marital status.Methods:A mixed methods literature review was performed to examine factors associated with OSA evaluation. Eligible articles addressed patient, provider, or system-level factors impacting completion of an OSA diagnostic evaluation, care-seeking and/or adherence rates. An observational study was also conducted in a sample of at-risk adults who received OSA risk notification and recommendation for follow-up evaluation as part of an outpatient procedure. Logistic regression examined associations between adherence to a provider’s recommendation for OSA evaluation and demographic, clinical and health-related factors. Linear regression examined these same factors and associations between OSA care-seeking intention stratified by age, sex, and marital status.Results/Conclusion:Twenty-six articles including quantitative, qualitative, and mixed methods studies were included in the literature review. Factors found to be most influential to OSA careseeking and/or evaluation were social support, sex and the influence of gender, OSA-related symptoms and experiences, OSA knowledge and beliefs, healthcare provider involvement, and administrative considerations. In the original research arm of this study, in a sample of 63 patients identified as at-risk for OSA in the perianesthesia setting, 12.7% adhered to a provider’s recommendation for follow-up evaluation. Excessive daytime sleepiness was identified as the strongest predictor of follow-up adherence. Functional impairment related to sleepiness and perceived likelihood of having OSA were the strongest predictors of OSA care-seeking intention. Functional impairment was important to OSA care-seeking intention in younger adults and regardless of sex or marital status; perceived likelihood of having OSA was an important predictor in men.