Community Pharmacies in Early Detection of Obstructive Sleep Apnea: Findings from a Nationwide Survey

Francesco Giombi¹Luca Cerri^2,3*Michele Cerasuolo¹Gian Marco Pace^2,3Giulio Sandri^2,3Alberto Braghiroli⁴Giuseppe Mercante^2,3Giuseppe Spriano^2,3Michele Cucchi⁵Stefano Aliberti^2,6Enrico Heffler^2,7Walter Canonica^2,7Giovanni Paoletti^2,7Enrico Keber⁸Corrado Giua⁸SIFAC Group⁸Luca MALVEZZI^2,3

• ¹Otorhinolaryngology- Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, Italy
• ²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
• ³Otorhinolaryngology- Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
• ⁴Sleep Care Center, Humanitas Mater Domini Hospital, Castellanza, Italy
• ⁵Humanitas Medical Care Division, Head of Clinical Product & Solution, Rozzano, Italy
• ⁶Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
• ⁷Personalized Medicine, Asthma and Allergy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
• ⁸Societa Italiana Farmacia Clinica, Cagliari, Italy

Introduction: Obstructive sleep apnea (OSA) is a highly prevalent, yet underdiagnosed sleep disorder associated with cardiovascular, metabolic, and neurocognitive morbidity, as well as impaired quality of life. Limited access to diagnostics, low public awareness, and underreporting of symptoms contribute to a substantial gap in detection. Community pharmacies, given their accessibility and frequent interaction with patients managing multiple comorbidities, represent a promising but underexplored setting for identifying individuals at high risk. Objective: To investigate the feasibility of pharmacy-based screening for OSA and to provide preliminary insights into the prevalence of at-risk individuals among pharmacy clients. Methods: A cross-sectional study was conducted in 22 Italian community pharmacies, where participants completed a three-section questionnaire recording demographic data, the Berlin Questionnaire (BQ) for OSA screening and the Pittsburgh Sleep Quality Index (PSQI) for sleep quality assessment. Multivariate regression was performed to explore the association between poor questionnaire outcomes, demographic variables, and ongoing medication use. A sensitivity analysis was conducted to minimize the risk of bias. Results: A total of 301 individuals were included (females: n=169/301, 56.15%). One-hundred-sixteen subjects (38.5%, n=301) scored positively in at least two categories of the BQ and were hence classified as at-risk. At sensitivity analysis, BMI (OR = 1.15, 95%CI: 1.07 – 1.24, p < 0.001), and ongoing antihypertensive medications (OR = 2.02, 95%CI: 1.78 – 3.11, p = 0.002) were associated with poor BQ outcome. A significantly higher PSQI score was observed compared to previously reported values in healthy individuals. However, no significant associations were observed between poor sleep quality and patients' demographics, or ongoing medication use. Conclusions: Community pharmacies can serve as a valuable setting for the early identification of individuals at risk for sleep-related breathing disorders, particularly among patients with multiple comorbidities. By leveraging their accessibility and frequent patient contact, pharmacies may complement existing healthcare pathways and support efforts aimed at reducing the current diagnostic gap in OSA.