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Temporal trends in Polysomnography Request by Specialties in a Large Private Service in Brazil: the Importance of Cardiology in OSA diagnosis.


In the last decades, Obstructive Sleep Apnea (OSA) has gained growing
interest in the cardiovascular field by the evidence linking OSA with hypertension, atrial
fibrillation, coronary artery disease, congestive heart failure and stroke. The translation of
the scientific evidence into clinical practice is challenging, especially in nontraditional sleeprelated areas such as in Cardiology. The lack of formal training in sleep medicine, medical
inertia and the recent neutral results from large randomized trials addressing the impact of
OSA treatment on cardiovascular disease may influence the OSA awareness in the
Cardiology setting.


Here, we tested this concept evaluating the temporal trend (11 years) of
polysomnography (PSG) requesting from different specialties from a large private service of
sleep medicine in Brazil.


This is a retrospective study conducted by the FleuryTM group
from 2008 to 2018. We revised all PSG performed at this 10 years period checking the
medical specialty (based on the medical license number and database from the service) who
requested the sleep study. For each year, we measured the percentage of PSG exams
requested by each specialty.


During this period, a number of 16.670 PSG were performed at the FleuryTM.
Beyond the expected role of a sleep-related specialty in requesting PSG
(Otorhinolaryngology was the top one with 29% of the total requests), Cardiology was
surprisingly the second most PSG requesting (16%), followed by Neurology (8%),
Endocrinology (8%) and Internal Medicine (5%). In the temporal trend analysis, we
observed a huge increase of PSG requesting by Cardiologists from 2009 to 2013
(2009:+7%, 2010: +22%, 2011: +59%, 2012: +11%, 2013: +30% as compared to 2008).
From 2014 to 2018 we observed an oscillatory pattern, but Cardiology specialties remained
in the second position during the whole period.


Despite the aforementioned barriers for OSA awareness in the Cardiology
setting, Cardiologists in Brazil may have an important role for triggering sleep studies for
OSA diagnosis. Considering the huge frequency of OSA among the cardiovascular diseases,
continuous efforts for provide formal training in sleep medicine in Cardiology may be useful
for decreasing OSA underdiagnosis in clinical practice.


obstructive sleep apnea, sleep medicine, cardiologists, polysomnography


Área Clínica


Sofia Fontanello Furlan, Bianca A Campos, Maria Carolina T Pintão, Paola Emanuela P Smanio, Luciano Ferreira Drager, Rosana S. C Alves