Knowledge, attitude, and practices of Filipino adult neurologists on obstructive sleep apnea among stroke patients

Objectives

This study aimed to describe the knowledge, attitudes, and practices of Filipino adult neurologists in the recognition and treatment of obstructive sleep apnea (OSA) among patients presenting with acute stroke.

Methodology

A prospective cross-sectional study was conducted using a web-based survey from April to June 2022 among active locally-practicing adult neurology fellows of the Philippine Neurological Association. The 18-item knowledge statements from the validated “Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) Questionnaire was used as survey instrument. There were also eight additional items assessing knowledge, six items assessing attitudes, and ten items assessing practices that were included.

Results

A total of 119 neurologists participated in the survey. Two-thirds of the respondents were females, and 70 % were between 31 and 40 years old. Majority of the respondents are General Neurologists (57.1 %) followed by Neurophysiologists (10 %) and Stroke Specialists (10 %). Forty-seven percent of neurologists got more than or equal to 75 % of the knowledge statements included in the OSAKA questionnaire correctly. Less than half of the respondents correctly answered the questions on (1) uvulopalatopharyngoplasty as curative for majority of patients with OSA (32.8 %), (2) continuous positive airway pressure (CPAP) therapy can cause nasal congestion (42.9 %), (3) laser-assisted uvuloplasty as treatment for severe OSA (16.8 %), and (4) less than 5 apneas is normal in adults (48.7 %). Majority (>80 %) of the respondents were able to correctly answer the statements relating OSA and stroke. Almost all agreed that OSA as a clinical disorder (95 %) is important and that acute stroke patients with possible OSA needs to be identified (94.1 %) and further evaluated (96.6 %). On the other hand, less than half of the respondents feel confident in: identifying patients at-risk for OSA (47.9 %), ability to manage acute stroke patients with OSA (34.5 %), and ability to manage acute stroke patients with OSA on CPAP therapy (21 %). Most neurologists would sometimes screen OSA among their patients with acute stroke (55.5 %). Most respondents would only educate their patients on OSA sometimes (43.7 %). With regards to the diagnosis (42 %), risk factors (42 %), and treatment options for OSA (40.3 %), most would discuss them with their patients.

Conclusion

Less than half of neurologists were able to get at least 75 % of the knowledge questions. Majority had difficulty with statements pertaining to surgery as cure for OSA, CPAP therapy causing nasal congestion, and OSA severity classification. Almost all has a positive attitude towards the importance of OSA diagnosis and management; however, there is low confidence among them with regards to their practice in identification and handling of these patients.