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

ArticleinThe Journal of the American Board of Family Medicine 20(4):365-74 · July 2007with7 Reads
DOI: 10.3122/jabfm.2007.04.060153 · Source: PubMed
Abstract
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.
    • "The prevalence of RLS in residents of Western countries >18 years of age was estimated to be 8.5%-28.2% [6,7]. The prevalence of RLS in Asian populations has been shown to be much lower, ranging from 0.1% to 12% [8,9] . "
    [Show abstract] [Hide abstract] ABSTRACT: The primary objective of this study was to investigate the prevalence and risk factors of restless legs syndrome (RLS) in an adult Chinese population living in a rural community. We also aimed to determine the predictive diagnostic value of the 4-item screening questionnaire for RLS in this population. This study was designed as a 2-phase survey. In phase 1 we performed a face-to-face interview of eligible individuals living in a rural community in Shanghai using a 4-item screening questionnaire. In phase 2, sleep specialists performed a phone interview of the individuals who screened positive to diagnosis RLS. Forty-one RLS cases were confirmed among 2941 eligible individuals 18 years of age or older in the study community. The prevalence of RLS was 1.4% (95% confidence interval (CI) =1.0-1.9%), with a significantly higher rate observed in females (1.9% [95%CI =1.3-2.7%]) than that in males (0.9% [95%CI =0.5-1.5%], p=0.019). The prevalence rate increased significantly with age, from 0.2% (95% CI =0.08-0.6%) in those 18-39 years old to 4.1% (95% CI =2.1-7.9%) in those ≥70 years old (p<0.001). The multivariate logistic regression analysis indicated that gastritis, anemia and hypertension were risk factors for RLS. The sensitivity and specificity of the 4-item screening questionnaire used in this study were 63.4% and 97.5%, respectively. RLS prevalence is relatively low among Chinese adults living in rural Shanghai. Furthermore, population-based studies with a larger sample size and a longitudinal follow-up may help to determine the risk factors of RLS and potential interventions for RLS.
    Full-text · Article · Mar 2015
    • "Interestingly, the hours of sleep education in NP programs reported by the participants (1.97 h) is similar to physician reports of 2.1 h in medical school (Harding & Berner, 2002) and a previous larger sample of this group (n = 169) of 2.1 h (Valerio, 2008a). Other studies (Alattar et al., 2007; Kryger et al., 2005; Lettieri et al., 2005; Young et al., 2002) have found that the " typical patient " has been much more readily identified . In this study, the pretest and posttest scores identified knowledge of the " typical patient " at risk for OSA particularly in the areas of snoring, witnessed apnea, excessive sleepiness, reduced concentration, obesity, hypertension and motor vehicle crashes. "
    [Show abstract] [Hide abstract] ABSTRACT: This study was conducted to determine the effects of an online educational program on nurse practitioner's (NP's) knowledge of identifying and evaluating adults at-risk for obstructive sleep apnea (OSA). Knowledge was assessed with a 15 question pre-test and post-test, after a 53 minute narrated PowerPoint educational session. Pre-test and post-test answers were compared to determine the change in knowledge. Fifty-four participants entered the study, and 38 (70.4%) completed. NPs that completed the entire OSA program (n = 38) had a significant improvement in post-test scores as compared to pre-test scores (p < .001, t(37 = -5.024). This was particularly evident (p = .05) in the areas of clinical prevalence, routine health evaluation, signs and symptoms, high risk situations and screening tools. After the educational session, 97.4% of participants indicated they were "very likely" or "likely" to evaluate their patients for OSA. NPs have limited formal education on sleep disorders, although are in a key position to make a significant impact on evaluating adults for OSA. Regular screening to identify adults with OSA would likely lead to improving the rate of diagnosis and reducing the associated chronic health problems.
    Full-text · Article · Nov 2014
    • "Thirty percent of adults experience occasional insomnia, and between 9 and 12 % of the adult population suffer severe chronic insomnia [23, 24]. In primary care settings, prevalence estimates for chronic insomnia center range from 32 to 34 % [25, 26]. Insomnia was once thought to be simply a symptom of an underlying disease, but it is now recognized as an independent condition warranting treatment [15, 27]. "
    [Show abstract] [Hide abstract] ABSTRACT: The military population is particularly vulnerable to a multitude of sleep-related disorders owing to the type of work performed by active duty servicemembers (ADSMs). Inadequate sleep, due to insufficient quantity or quality, is increasingly recognized as a public health concern. Traditionally, ADSMs have been encouraged that they can adapt to insufficient sleep just as the body adapts to physical training, but there is a substantial body of scientific literature which argues that this is not possible. Additionally, the military work environment creates unique challenges with respect to treatment options for common sleep disorders like obstructive sleep apnea, restless legs syndrome, and parasomnias. This review highlights sleep disorders which are prevalent in the modern military force and discusses the impact of poor sleep on overall performance. Medical treatments and recommendations for unit leaders are also discussed.
    Full-text · Article · Aug 2014
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