Cardiologist's evaluation of obstructive sleep apnea in those patients admitted with chest pain

Purpose: Obstructive sleep apnea (OSA) has previously been demonstrated to be an independent risk factor for myocardial infarction (MI). We hypothesized that a minority of practicing clinical cardiologists routinely question patients about signs and symptoms of OSA. Methods: A questionnaire was designed and administered to patients admitted for "chest pain". The questionnaire asked patients if their primary care physician or their cardiologist ever asked them questions about the signs and symptoms of OSA. The questionnaire also asked whether the patient ever told a physician about the signs and symptoms of OSA. A risk analysis for OSA was conducted on each patient. Results: One hundred consecutive patients completed the questionnaire after being admitted with the diagnosis of USA or "Rule out MI". These patients were admitted to the service of 53 different primary care physicians and seen by a total of 15 different cardiologists. Twenty-three (25%) patients were considered to have very high probability of OSA, 10 (11 %) high, 22 moderate (24 %), 38 (41%) low probability of having OSA. Nine patients (0.9 %) were asked by their primary care physician about the signs and symptoms of OSA. Likewise, 5 patients (0.5 %) were asked similar questions by their cardiologist. Conclusions: This study demonstrates that most physicians, including attending cardiologists, are lax about ascertaining whether patients exhibit the classic signs and symptoms of OSA, a known risk factor for myocardial infarction. Clinical Implications: This studies supports the findings that many physicians, including sub specialist are uninformed about the clinical implications of OSA. This report will be made available to these physicians and a follow up study will further investigate our success in educating the involved physicians about the signs, symptoms and risks of OSA.