Physician knowledge and attitudes towards screening and referral for obstructive sleep apnea: a mixed methods study in a tertiary care hospital

Abstract

# Background Cardiovascular diseases have risen to be the top cause of mortality and morbidity globally and at a faster pace in developing countries. Obstructive sleep apnea (OSA) is an established common denominator, severely underdiagnosed, and a potentially modifiable risk factor for non-communicable diseases (NCDs). Our study is a mixed methods evaluation of knowledge and attitudes among physicians about OSA, from a tertiary care hospital in Bangalore, South India, and how it is integrated into their practice of screening and referral for OSA diagnosis and treatment. # Methods We did an interview, semi-structured and qualitative, along with a validated questionnaire; OSAKA (Obstructive Sleep Apnea Knowledge and Attitudes). The objective of the study was to gain insights into how knowledge and attitudes about OSA reflected qualitatively in physicians’ daily practice of screening and referral for suspected OSA. # Results The mean OSAKA knowledge score across our sample was 12.31 (± 2.7). This level of awareness was as high as other OSAKA studies that have been conducted worldwide. However, the qualitative data from interviews highlights that physicians are not regularly screening for and thinking about OSA on a daily basis, yet these clinicians discussed regularly managing other symptoms and chronic conditions strongly associated with OSA. There were five key themes across the interviews that were used to inform recommendations for improving integration of physicians’ knowledge about OSA into clinical practice. # Conclusions Despite a relatively high knowledge score among the clinicians, it did not influence the clinician behavior to implement a screening and referral system for OSA in their daily practice. Knowledge and attitudes alone cannot change clinician behavior. Given that OSA is a modifiable risk factor for various NCDs, there is an urgent need to implement better screening and efficient referral systems for correction of OSA.