Sedating medications and undiagnosed obstructive sleep apnea: physician determinants and patient consequences.

Brandon Lu, Rohit Budhiraja, Sairam Parthasarathy

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

BACKGROUND: Sedative medications may be inadvertently prescribed to patients with undiagnosed obstructive sleep apnea (OSA) and may worsen daytime sleepiness. STUDY OBJECTIVES: To determine whether patients with undiagnosed OSA were prescribed sedative medications and whether such prescriptions increased the risk for traffic accidents. A secondary objective was to determine physician characteristics associated with such prescription practices. DESIGN: Retrospective chart review. Telephone interviews of patients and physicians. INTERVENTION: None. PATIENTS: One hundred fifty-one consecutive patients at a sleep laboratory. RESULTS: Forty-one of 137 (30%) patients with undiagnosed OSA had received prescriptions for sedating medications. Regression analysis identified self-report of sleepiness while driving (p = .05) and prescription for risperidone as independent risk factors for motor vehicle accidents (p = .005), while prescription of any sedative (excluding risperidone) tended to be associated with accidents (p =.10). In patients with severe OSA, prescription of sedating medications was associated with a greater risk for motor vehicle accidents than those without such prescriptions (relative risk = 2.6; p = .04). In patients with prescription for sedating medications (n = 41), the apnea-hypopnea index was directly proportional to the risk for motor vehicle accidents (r2 = 0.26; p = .001) suggesting a 'dose effect' of severity of sleep-disordered breathing on risk for accidents. Physicians who did not usually treat patients with sleep disorders were more likely to prescribe sedatives to patients with undiagnosed OSA than were physicians with such expertise: neurologist, pulmonologist, or psychiatrist (52% vs 10%; relative risk = 5.2; p = .02) CONCLUSION: Prescription of sedating medications may increase the risk of road accidents in patients with undiagnosed severe OSA, and such prescription practices are less likely to occur in physicians with expertise in sleep medicine.

Original languageEnglish (US)
Pages (from-to)367-371
Number of pages5
JournalJournal of Clinical Sleep Medicine
Volume1
Issue number4
StatePublished - Oct 15 2005
Externally publishedYes

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Obstructive Sleep Apnea
Prescriptions
Physicians
Accidents
Hypnotics and Sedatives
Motor Vehicles
Risperidone
Sleep
Traffic Accidents
Sleep Apnea Syndromes
Apnea
Self Report
Psychiatry
Regression Analysis
Medicine
Interviews

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

Cite this

Sedating medications and undiagnosed obstructive sleep apnea : physician determinants and patient consequences. / Lu, Brandon; Budhiraja, Rohit; Parthasarathy, Sairam.

In: Journal of Clinical Sleep Medicine, Vol. 1, No. 4, 15.10.2005, p. 367-371.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Sedative medications may be inadvertently prescribed to patients with undiagnosed obstructive sleep apnea (OSA) and may worsen daytime sleepiness. STUDY OBJECTIVES: To determine whether patients with undiagnosed OSA were prescribed sedative medications and whether such prescriptions increased the risk for traffic accidents. A secondary objective was to determine physician characteristics associated with such prescription practices. DESIGN: Retrospective chart review. Telephone interviews of patients and physicians. INTERVENTION: None. PATIENTS: One hundred fifty-one consecutive patients at a sleep laboratory. RESULTS: Forty-one of 137 (30{\%}) patients with undiagnosed OSA had received prescriptions for sedating medications. Regression analysis identified self-report of sleepiness while driving (p = .05) and prescription for risperidone as independent risk factors for motor vehicle accidents (p = .005), while prescription of any sedative (excluding risperidone) tended to be associated with accidents (p =.10). In patients with severe OSA, prescription of sedating medications was associated with a greater risk for motor vehicle accidents than those without such prescriptions (relative risk = 2.6; p = .04). In patients with prescription for sedating medications (n = 41), the apnea-hypopnea index was directly proportional to the risk for motor vehicle accidents (r2 = 0.26; p = .001) suggesting a 'dose effect' of severity of sleep-disordered breathing on risk for accidents. Physicians who did not usually treat patients with sleep disorders were more likely to prescribe sedatives to patients with undiagnosed OSA than were physicians with such expertise: neurologist, pulmonologist, or psychiatrist (52{\%} vs 10{\%}; relative risk = 5.2; p = .02) CONCLUSION: Prescription of sedating medications may increase the risk of road accidents in patients with undiagnosed severe OSA, and such prescription practices are less likely to occur in physicians with expertise in sleep medicine.",
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