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Medline ® Abstracts for References 2,3

of 'Sleep disorders in hospitalized adults: Evaluation and management'

Evaluation of sleep disorders in the primary care setting: history taking compared to questionnaires.
Senthilvel E, Auckley D, Dasarathy J
J Clin Sleep Med. 2011 Feb;7(1):41-8.
STUDY OBJECTIVES: The objective of this study was to determine if primary care providers (PCPs) screen for sleep disorders during clinical evaluation of new patients, and to compare this to likely sleep diagnoses as assessed by validated questionnaires.
METHODS: Adult patients evaluated as new patients in a primary care clinic at a tertiary care center were included in a prospective study. Following their appointment, patients completed the Cleveland Sleep Habits questionnaire (CSHQ), Berlin questionnaire, Epworth Sleepiness Scale (ESS), and STOP questionnaire. The encounters were subsequently reviewed for elements of a sleep history, sleep review of systems, and/or sleep workup.
RESULTS: 101 patients participated in the study.
DEMOGRAPHICS: 58 (52%) females, mean age 38±12.9 years, body mass index (BMI) 29.5±8.3 kg/m²(BMI>30 kg/m²in 44%), 46% Caucasian, 38% African American, 11% Hispanic, and 5% other. House staff evaluated 57.4%; faculty evaluated the remainder. The ESS was>10 in 28% of subjects. High risk for obstructive sleep apnea (OSA) risk was found in 33% (Berlin) and 34% (STOP) (24.8% by both). The CSHQ suggested possible diagnoses of insomnia in 30% and restless legs syndrome in 22%. In the clinic encounters, a limited sleep history was found in 24.8%, documentation of a sleep disorder in 8.9%, referral to sleep clinic in 2%, and referral to psychiatry clinic in 6.9%.
CONCLUSION: Symptoms suggestive of sleep disorders are common but are not routinely screened for in the primary care setting. Validated questionnaires can efficiently identify patients at risk for common sleep disorders in this setting.
Department of Family Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Performance of sleep histories in an ambulatory medicine clinic: impact of simple chart reminders.
Namen AM, Wymer A, Case D, Haponik EF
Chest. 1999 Dec;116(6):1558-63.
BACKGROUND: The sleep history is essential to recognizing clinically important sleep disorders, but little is documented about its performance in the primary care setting.
STUDY OBJECTIVES: To estimate the frequency of documented sleep histories by medical house officers (HOs) in an ambulatory medicine clinic and to assess whether a chart reminder influences their performance.
DESIGN: We reviewed the performance of medical HOs after introduction of a medical record form that included a simple sleep history prompt among reminders relating to health promotion. For each of 108 HOs, we randomly selected a chart with a sleep history prompt and one without.
RESULTS: Any sleep history was documented in only 37 of 216 medical records (17%), including 21 of 122 patients (17%) with risk factors for obstructive sleep apnea (OSA). Use of chart reminders was associated with nearly a fivefold increase of sleep histories (29% vs 6%, p<0.001), and charts with prompts had more notations about specific sleepcomplaints (2.6 +/- 0.9 vs 1.0 +/- 0.0 notes per patient, p<0.0001). Sleep histories were recorded less often (p<0.001) than histories of cigarette smoking or alcohol use. Although 24% of physicians appeared to be influenced by the prompt, sleep problems were included on problem lists of only six patients (3%). Overall, the frequencies of diagnostic studies (1% of all patients, 6% of those with sleep histories) or documented therapeutic recommendations (0%) relating to sleep were low, whether or not chart reminders were used, with sleep testing obtained in only one patient. Sleep interventions were documented less often than smoking cessation or weight loss (p<0.002).
CONCLUSIONS: Sleep histories are seldom documented by medical HOs, even in patients at risk for OSA. Use of a simple chart reminder was associated with an increased frequency of recorded sleep histories, but had no clear impact on diagnosis or treatment. If sleep problems and their management are to be prioritized appropriately, then the obstacles to obtaining sleep histories and to following up cues to sleep disorders must be clarified and overcome.
Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.