Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.
Sleep apnoea
Obstructive sleep apnoea (OSA) is a chronic condition characterised by repetitive episodes of upper airway collapse during sleep and is associated with cardiovascular disease, stroke, and reduced quality of life. It can be treated with continuous positive airway pressure (CPAP), but many individuals remain undiagnosed and untreated. This study in England aimed to provide current epidemiological evidence on the burden of OSA in England from 2009–2021.1 The overall diagnosed incidence of OSA was 65.06 per 100 000 person–years rising steadily from 2010–2019. The median waiting time from GP referral to the first sleep clinic was 37 days, and from first sleep clinic to OSA diagnosis was closer to two months. The median time from OSA diagnosis to CPAP therapy was >2 months, meaning total median time from GP referral to CPAP was >6 months. This feels quicker than my experience in practice where difficult conversations about driving must be had at the point of a suspected diagnosis while facing restrictive referral criteria and long clinic waiting lists.
“This opinion piece from the Netherlands explores a key topic in how we could approach PSS without an underlying disease process: predictive processing.”
Persistent physical symptoms
Persistent physical symptoms (PSS) are distressing somatic complaints that last several months or more regardless of their cause. They are common in chronic disease, but around a third cannot be attributed to a recognised condition. They are a major determinant of quality of life and can severely impact patients’ daily activities. This opinion piece from the Netherlands explores a key topic in how we could approach PSS without an underlying disease process: predictive processing.2 This is a theoretical framework for understanding how the brain generates perception and argues that to generate perceptions including bodily symptoms, the brain combines prior expectations (‘priors’) with incoming sensory signals. This can therefore explain why symptoms do not always correspond with measurable pathology. As the authors put it, this framework ‘proposes that the relationship between structural pathology and symptoms varies along a continuum and depends on context’. This can be a useful framework for discussions with patients with chronic symptoms and normal tests.
Health inequalities by language proficiency
At the time of the 2021 census, >1 million people in the UK could not speak English well or at all. English proficiency is a key determinant of social support and integration and is also important for accessing health care in the UK, with complex systems that can be difficult to navigate even for native English speakers. This study used healthcare records in Brent, London, to quantify levels of healthcare use by language proficiency.3 Patients with poor English proficiency but with English as a recorded first language had the poorest health status, with higher prevalence of serious mental illness, epilepsy, dementia, learning disability, obesity and diabetes. For patients with poor English proficiency but with a non-English recorded first language in the last 4 years, use of healthcare services was higher across all areas. The authors suggest this could be due to higher numbers of primary care encounters required to reach diagnoses or treatment plans, while difficulties accessing preventative services could lead to higher use of urgent or emergency services.
New-onset diabetes
Pancreatic cancer is diagnosed in 0.5%–1% of people with new-onset diabetes (NOD), with this risk increasing to 3% when NOD is concurrent with unexplained weight loss, particularly in older adults. NICE guidance recommends urgent abdominal imaging for people aged ≥60 years with unexplained weight loss and NOD. This UK database study explored abdominal imaging rates in this patient cohort.4 Within 12 months before or after diabetes diagnosis, only 26% of eligible patients were recorded as having been referred for or having received abdominal imaging. While there are inherent limitations in most database studies with the reliance on quality and quantity of coding in electronic health records, this suggests we may be under-investigating in this patient group. There is apparently an NHS England pilot underway looking at how to improve referrals for abdominal imaging in this scenario, so watch this space.
References
1. Ali A, Deger M, Ghildiyal A, et al. Incidence, characteristics, and management pathways of obstructive sleep apnea in England: a 10-year retrospective cohort study. CHEST Pulm 2026; 4(1): 100221.
2. van Boven K, Lucassen P, Hartman TCO, Van den Bergh O. Beyond diagnosis in general practice: predictive processing, a novel framework for persistent physical symptoms. Eur J Gen Pract 2026; 32(1): 2717019.
3. Yeoh S, Stafford M. Exploring health inequalities by language proficiency; a routine health records study set in England. PLoS One 2026; 21(8): e0342624.
4. Lemanska A, Claridge H, Price CA, et al. Primary care referrals and abdominal imaging in people with new-onset diabetes and weight loss: cohort study using the English national sentinel network database. BMJ Open 2026; 16(8): e119662.
Featured photo by Megan te Boekhorst on Unsplash.
