title: Diagnosis and treatment of sleep apnea within the community. The Walla Walla Project.
abstract: BACKGROUND
  Patients with sleep disorders are common in primary care, yet most physicians lack training in the diagnosis and treatment of such patients.
  
  
  OBJECTIVE
  To enhance recognition of sleep disorders by community physicians and transfer the diagnostic testing and care of such patients from tertiary care centers to the local community. To present our polysomnogram experience relevant to sleep apnea.
  
  
  METHODS
  Sleep disorders specialists provided a community with education, diagnostic equipment, and ongoing support as sleep disorders expertise was established locally. Outcomes for a 2-year period were assessed by chart review, patient questionnaire, tabulation of polysomnographic data, and comparison with published reports from specialized centers.
  
  
  RESULTS
  Referral for sleep testing increased by almost 8-fold in patients at the Walla Walla Clinic in Walla Walla, Wash, from 0.27% (2 of 752 cases reviewed) to 2.1% (294 of 14330 internal medicine patients). Data were collected from all community physicians for a 2-year period on 360 new patients who underwent polysomnogram testing. This resulted in the diagnosis of sleep-related breathing disorders in 81% and periodic leg movements of sleep in 18%. Nasal continuous positive airway pressure treatment was given to 228 patients (average baseline apnea index of 19.1), representing a higher volume of patients than at many traditional sleep centers, yet compliance with continuous positive airway pressure was comparable.
  
  
  CONCLUSIONS
  Sleep apnea is significantly underrecognized by primary care physicians. As a result of the intervention, local sleep expertise was established and large numbers of patients were discovered and treated in the community. Thus, a significant public health problem is identified and a solution established.
authors.affiliation: Department of Internal Medicine, Walla Walla Clinic, Wash, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Ball
authors.forename: R D
authors.initials: RD
authors.lastname: Simon
authors.forename: A A
authors.initials: AA
authors.lastname: Tall
authors.forename: M B
authors.initials: MB
authors.lastname: Banks
authors.forename: G
authors.initials: G
authors.lastname: Nino-Murcia
authors.forename: W C
authors.initials: WC
authors.lastname: Dement
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D011320:Primary Health Care; D012017:Referral and Consultation; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014861:Washington