title: Assessing the prioritization of primary care referrals for polysomnograms.
abstract: OBJECTIVE
  The mortality attributed to obstructive sleep apnea (OSA) is comparable to that of breast cancer and colon cancer. We sought to determine if patients at high risk for OSA were less likely to be referred by their primary care physician for polysomnograms (PSG) than mammograms or endoscopies.
  
  
  METHODS
  Prospective cohort study; patients were recruited between January 2007 and April 2007.
  
  
  METHODS
  Academic public hospital system
  
  
  METHODS
  395 patients waiting for family or internal medicine primary care appointments were administered the Berlin questionnaire. Chart abstraction or interview determined demographics; insurance and employment status; body mass index (BMI); comorbidities; and prior PSG, mammography, or endoscopy referrals.
  
  
  RESULTS
  Mean BMI was 30 +/- 7.4 kg/m2; 187 (47%) patients had high-risk Berlin scores. Overall, 19% of patients with high-risk Berlin scores were referred for PSG, compared to 63% of those eligible for mammograms and 80% of those eligible for endoscopies. Women (OR = 2.9, P = 0.02), COPD (OR = 4.6, P = 0.03), high-risk Berlin scores (OR = 3.4, P = 0.009), and higher BMI (OR = 1.1, P < 0.001) were positively associated with PSG referrals. Privately insured patients were less likely to be referred than uninsured patients (OR = 0.3, P = 0.04). There was no significant difference in referrals among those with other forms of insurance. Race was not associated with PSG referrals.
  
  
  CONCLUSIONS
  In a public hospital, primary care patients were less likely to be referred for PSG compared to mammogram and endoscopy. Uninsured patients were more likely to be referred for PSG than those with private insurance. Further studies are needed to address the low PSG referral rates in high-risk populations.
authors.affiliation: Center for Reducing Health Disparities, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH 44109, USA. daryl.thornton@case.edu
authors.forename: J Daryl
authors.initials: JD
authors.lastname: Thornton
authors.forename: Kinnari
authors.initials: K
authors.lastname: Chandriani
authors.forename: Julia G
authors.initials: JG
authors.lastname: Thornton
authors.forename: Sobia
authors.initials: S
authors.lastname: Farooq
authors.forename: Moayyed
authors.initials: M
authors.lastname: Moallem
authors.forename: Vidya
authors.initials: V
authors.lastname: Krishnan
authors.forename: Dennis
authors.initials: D
authors.lastname: Auckley
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003113:Colonoscopy / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006292:Health Priorities; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D020380:Needs Assessment; D017286:Polysomnography / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*