ABSTRACT
Objectives: This survey sought to determine whether self-professed sleep specialists
in the State of Michigan show practice variations in the diagnosis and management
of sleep-disordered breathing (SDB), and whether such variations occur between pulmonologists
and neurologists. Methods: Questionnaires on practice volume and patterns during the
prior 12 months were mailed to physician members of the Michigan Sleep Disorders Association
(n = 119); 67 were completed and returned. Results: Respondents reported that they personally
saw a median of 8 new patients each week for suspected SDB; estimates were that 86%
of these patients were eventually confirmed to have SDB. Most patients (82%) had laboratory-based
polysomnography after an initial clinic evaluation, and most (69%) of those treated
for SDB received continuous positive airway pressure. However, practice patterns differed
substantially among respondents, even when the analysis was limited to the 42 who
reported board certification by the American Board of Sleep Medicine. For example,
among all surveyed practices the likelihood that suspected SDB would be evaluated
with a split-night diagnostic and treatment polysomnogram varied from 0 to 90%. The
likelihood of SDB treatment with bilevel positive airway pressure varied from 0 to
50%, with automatically titrating devices from 0 to 100%, with surgery from 0 to 100%
(0 to 50% among certified practitioners), and with oral appliances from 0 to 20%.
The practice patterns of pulmonologists and neurologists did not differ significantly.
Conclusion: Approaches to SDB vary widely in Michigan, though not according to clinician
background in pulmonary medicine or neurology. A patient's experience, in both assessment
and treatment, could differ substantially based on which clinician is consulted.
KEYWORDS
Sleep apnea syndromes - physician's practice patterns - polysomnography - continuous
positive airway pressure
