Detection and screening of obstructive sleep apnea in primary care


  • Marwah Yakoop Abdullah Department of Family Medicine, East Jeddah Hospital, Jeddah, Saudi Arabia
  • Abdulrahman Hasan Kailani College of Medicine, Jazan University, Jazan, Saudi Arabia
  • Ali Malik Alnasser Department of Internal Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
  • Hisham Hamdoon Alqari General Physician, Ministry of Health, Jeddah, Saudi Arabia
  • Shahd Ayed Alharbi General Physician, Ministry of Health, Jeddah, Saudi Arabia
  • Saeed Saad Alshahrani Department of Emergency Medicine, Ahad Rafidah General Hospital, Abha, Saudi Arabia
  • Shahad Idhah Alzahrani College of Medicine, Medical University of Lublin, Lublin, Poland
  • Nariman Ayman Fageeh Department of Otolaryngology, Al Noor Specialist Hospital, Mecca, Saudi Arabia
  • Nada Waleed Alharbi Department of Family Medicine, Ghurnata Primary Healthcare Center, Dammam, Saudi Arabia
  • Abdulilah Mohammed Albaqami Department of Psychiatry, Erada and Mental Health Complex, Taif, Saudi Arabia
  • Abdullah Mohammed Alsuaylik Department of Blood Bank, Prince Saud bin Jalawi Hospital, Al Ahsa, Saudi Arabia



OSA, Cardiovascular, Screening, Sleep disorders


The most prevalent sleep-related breathing condition, obstructive sleep apnea (OSA), is linked to greater morbidity and poor cardiovascular outcomes. Even though sleep disorders are frequently present, primary care physicians hardly see or treat them. Better OSA symptom and intensity identification and classification to support OSA evaluation and diagnosis were the first outcomes of a task group of the American Academy of Sleep Medicine that produced quality metrics for the treatment of adult patients with the condition in 2015. The OSA screening tools (Berlin questionnaire, Epworth sleepiness scale, STOP Bang) have proven to be effective instruments for screening of sleep disorders. The present primary care practice approach for OSA screening and evaluation is disorganized and inadequate.  Patients with OSA symptomatology are seen by primary care physicians, but they are not regularly screened, assessed, or referred to a sleep specialist. For the OSA screening assessments in general practice, more psychometric investigations are required. The findings from these investigations can be applied in real-world settings to improve OSA identification.


Carson-DeWitt R. Conditions InDepth: Sleep Apnea. wnyurology. 2022.

Campos-Rodriguez F, Martinez-Garcia MA, De la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Internal Med. 2012;156(2):115-22.

Qaseem A, Dallas P, Owens DK. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Internal Med. 2014;161(3):210-20.

Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11(2):e1001599.

Almendros I, Farré R, Torres M. Early and mid-term effects of obstructive apneas in myocardial injury and inflammation. Sleep Med. 2011;12(10):1037-40.

Xie X, Pan L, Ren D, Du C, Guo Y. Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: a meta-analysis. Sleep Med. 2013;14(11):1139-50.

Gottlieb DJ, Craig SE, Lorenzi-Filho G. Sleep apnea cardiovascular clinical trials-current status and steps forward: the International Collaboration of Sleep Apnea Cardiovascular Trialists. Sleep. 2013;36(7):975-80.

Aurora RN, Collop NA, Jacobowitz O, Thomas SM, Quan SF, Aronsky AJ. Quality measures for the care of adult patients with obstructive sleep apnea. J Clin Sleep Med. 2015;11(3):357-83.

Bailes S, Baltzan M, Rizzo D, Fichten CS, Amsel R, Libman E. A diagnostic symptom profile for sleep disorder in primary care patients. J Psychosomatic Res. 2008;64(4):427-33.

Bailes S, Baltzan M, Rizzo D. Sleep disorder symptoms are common and unspoken in Canadian general practice. Family Pract. 2009;26(4):294-300.

Bartlett DJ, Marshall NS, Williams A, Grunstein RR. Predictors of primary medical care consultation for sleep disorders. Sleep Med. 2008;9(8):857-64.

Grover M, Mookadam M, Armas D. Identifying patients at risk for obstructive sleep apnea in a primary care practice. J Am Board Family Med. 2011;24(2):152-60.

Burgess KR, Havryk A, Newton S, Tsai WH, Whitelaw WA. Targeted case finding for OSA within the primary care setting. J Clin Sleep Med. 2013;9(7):681-6.

Jennum P, Ibsen R, Kjellberg J. Morbidity prior to a diagnosis of sleep-disordered breathing: a controlled national study. J Clin Sleep Med. 2013;9(2):103-8.

Zhao L-P, Tan A, Tai B-C, Loo G, Tan H-C, Lee C-H. Effects of gender on the prevalence of obstructive sleep apnea in patients with coronary artery disease. J Clin Sleep Med. 2014;10(12):1279-84.

Attarian HP, Viola-Saltzman M. Sleep disorders in women. Springer. 2006.

Adams RJ, Piantadosi C, Appleton SL. Investigating obstructive sleep apnoea: will the health system have the capacity to cope? A population study. Austr Heal Rev. 2012;36(4):424-9.

Kim JI, Sillah A, Boucher JL, Sidebottom AC, Knickelbine T. Prevalence of the A merican H eart Association's “Ideal Cardiovascular Health” Metrics in a Rural, Cross‐sectional, Community‐Based Study: The Heart of N ew U lm Project. J Am Heart Asso. 2013;2(3):e000058.

Melvin CL, Corbie-Smith G, Kumanyika SK. Developing a research agenda for cardiovascular disease prevention in high-risk rural communities. Am J Publ Heal. 2013;103(6):1011-21.

Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071-8.

Kim NH, Cho NH, Yun C-H. Association of obstructive sleep apnea and glucose metabolism in subjects with or without obesity. Diab Care. 2013;36(12):3909-15.

Cassar A, Morgenthaler TI, Rihal CS. Coronary endothelial function in patients with obstructive sleep apnea. Coronary Arter Dis. 2014;25(1):16.

Gottlieb DJ, Yenokyan G, Newman AB. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352-60.

Senthilvel E, Auckley D, Dasarathy J. Evaluation of sleep disorders in the primary care setting: history taking compared to questionnaires. J Clin Sleep Med. 2011;7(1):41-8.

Health UDo, Services H. Office of disease prevention and health promotion. Healthy People. 2020;2010.

Sorscher AJ. How is your sleep: a neglected topic for health care screening. J Am Board Fam Med. 2008;21(2):141-8.

Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus C, Vaughn BV. The AASM manual for the scoring of sleep and associated events. Rules, Terminology and Technical Specifications, Darien, Illinois. Am Academy Sleep Med. 2012;176:2012.

Peppard PE, Ward NR, Morrell MJ. The impact of obesity on oxygen desaturation during sleep-disordered breathing. Am J Respiratory Cri Care Med. 2009;180(8):788-93.

Medicine AOSATFotAAoS. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.

Butkov N, Lee-Chiong TL. Fundamentals of sleep technology. Lippincott Williams and Wilkins. 2007.

Ancoli-Israel S, Czeisler C, George C, Guilleminault C, Pack A. Expert panel recommendations: Obstructive sleep apnea and commercial motor vehicle driver safety. Washington, DC: US Department of Transportation, Federal Motor Carrier Safety Administration. 2008.

Mansfield DR, Antic NA, McEvoy RD. How to assess, diagnose, refer and treat adult obstructive sleep apnoea: a commentary on the choices. Med J Aust. 2013;199:S21-6.

Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anesthesia/ J Can D'anesthésie. 2010;57(5):423-38.

Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. J Am Society Anesthesiol. 2009;110(4):928-39.

Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales. J Clin Sleep Med. 2011.

Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Internal Med. 1999;131(7):485-91.

Chung F, Yegneswaran B, Liao P. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. J Am Society Anesthesiolog. 2008;108(5):822-30.

El-Sayed IH. Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egypt J Chest Dis Tubercul. 2012;61(4):433-41.

Chung F. Screening for obstructive sleep apnea syndrome in the preoperative patients. Open Anesthesia J. 2011;5(1).

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5.

Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376-81.

Chung F, Yegneswaran B, Liao P. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. J Am Society Anesthesiologists. 2008;108(5):812-21.

Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Bri J Anaesthesia. 2012;108(5):768-75.




How to Cite

Abdullah, M. Y., Kailani, A. H., Alnasser, A. M., Alqari, H. H., Alharbi, S. A., Alshahrani, S. S., Alzahrani, S. I., Fageeh, N. A., Alharbi, N. W., Albaqami, A. M., & Alsuaylik, A. M. (2022). Detection and screening of obstructive sleep apnea in primary care. International Journal Of Community Medicine And Public Health, 10(1), 464–468.



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