Sleep problems in primary care: A North Carolina Family Practice Research Network (NC-FP-RN) study

University of North Carolina at Chapel Hill, North Carolina, United States
The Journal of the American Board of Family Medicine (Impact Factor: 1.98). 07/2007; 20(4):365-74. DOI: 10.3122/jabfm.2007.04.060153
Source: PubMed


The prevalence and nature of sleep disorders in primary care has not been widely studied. As part of a survey conducted in 5 family practice offices in North Carolina, we screened adult patients for sleep syndromes and sought to ascertain which demographic status and health status were associated with these disorders.
We approached 2963 consecutive adults who presented for office visits to the 5 study practices. The 4-page study questionnaire, which was available in English and Spanish, included items on insomnia, excessive daytime sleepiness, obstructive sleep apnea syndrome, and restless legs syndrome. Analyses evaluated the relationship between sleep syndromes and demographic factors, health status, and disability.
We enrolled 1935 patients (65.3% response rate). More than half reported excessive daytime sleepiness, one third had insomnia, more than 25% had symptoms of restless legs syndrome, and 13% to 33% reported obstructive sleep apnea syndrome symptoms. Participants who rated their health as poor reported significantly higher rates of all sleep disturbance items. Patients with hypertension, pain syndromes, and depression had a significantly increased risk for all sleep complaints. Patients who reported limited activity had a significant risk of restless legs syndrome.
Sleep complaints are highly prevalent in primary care populations. Patients with the highest risk for sleep disturbance are those with pain, mental illness, limited activity, and overall "poor physical and mental health." Because sleep disorders are associated with a significant health impact, positive responses to questions regarding sleep symptoms should prompt further diagnostic inquiry.

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    • "Although the diagnostic yield from our study, in terms of the proportion of screened participants that were actually diagnosed, is low at 4% and 10% in the two groups, it is comparable to other pharmacy-based screening programs for conditions such as diabetes and cardiovascular disease that have a higher population prevalence than the targeted sleep disorders [1], [14], [31], [34]. This low diagnostic yield has occurred despite a targeted patient participant sampling approach that was based on symptoms, presence of comorbidities [35] or prescribed medications possibly associated with sleep disorders, that might potentially have recruited patients with a higher risk of sleep disorders than general pharmacy clients. Whether or not such a diagnostic yield leads to actual health and/or economic benefit is yet to be established in clinical studies. "
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    ABSTRACT: Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the number of participants identified in RAO or RA+ group who were likely to have and consequently be diagnosed with OSA. Further outcomes included the number of participants identified as being at risk for, referred for, taking-up referral for, and then diagnosed with OSA, insomnia, and/or restless legs syndrome (RLS) in either group.
    Full-text · Article · Jun 2014 · PLoS ONE
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    • "There have been 20 previous cross-sectional epidemiologic studies that have looked at the relationship between RLS and hypertension, heart disease, and stroke. Of these 20 studies, 15 suggested an increased risk of hypertension, CVD, CAD, cerebrovascular disease, or heart disease in patients with RLS/PLMS [2, 10, 14, 16, 40, 61, 71, 78, 84, 87, 97, 121, 132, 136, 137]. Five cross-sectional epidemiologic studies reported no associated or a reduced risk of hypertension and CVD compared to patients without RLS [30, 55, 101, 141, 142]. "
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    ABSTRACT: Untreated sleep disorders may contribute to secondary causes of uncontrolled hypertension, cardiovascular disease (CVD), and stroke. Restless legs syndrome, or Willis-Ekbom Disease (RLS/WED), is a common sensorimotor disorder with a circadian rhythmicity defined by an uncontrollable urge to move the legs that worsens during periods of inactivity or at rest in the evening, often resulting in sleep disruptions. Sleep disorders such as insomnia and obstructive sleep apnea (OSA) are established risk factors for increased risk of hypertension and vascular diseases. This literature review outlines the lessons learned from studies demonstrating insomnia and OSA as risk factors for hypertension and vascular diseases to support the epidemiologic and physiologic evidence suggesting a similar increase in hypertension and vascular disease risk due to RLS. Understanding the relationships between RLS and hypertension, CVD, and stroke has important implications for reducing the risks associated with these diseases.
    Preview · Article · Aug 2013 · Journal of Neurology
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    • "A majority of studies, however, do show a small yet significant relationship between RLS and obesity.106–113 This relationship has been demonstrated through a significantly greater BMI in those with RLS versus those without,107,113 an increased prevalence of RLS in obese versus nonobese individuals,109,110,112 or an increased prevalence of obesity in RLS versus non-RLS.106,111 These studies all adjusted for common confounding variables such as age, sex, and lifestyle factors (caffeine or alcohol consumption, smoking, physical activity). "
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    ABSTRACT: Decreased sleep duration and quality is associated with an increase in body weight and adiposity. Insomnia, obstructive sleep apnea, and restless legs syndrome are three of the most prevalent types of sleep disorder that lead to an increased risk for numerous chronic health conditions. Various studies have examined the impact of these sleep disorders on obesity, and are an important link in understanding the relationship between sleep disorders and chronic disease. Physical activity and exercise are important prognostic tools in obesity and chronic disease, and numerous studies have explored the relationship between obesity, sleep disorders, and exercise. As such, this review will examine the relationship between sleep disorders and obesity. In addition, how sleep disorders may impact the exercise response and how exercise may impact patient outcomes with regard to sleep disorders will also be reviewed.
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