RESUMEN
The worldwide COVID-19 pandemic has affected the operation of health care systems. The direct impact of obstructive sleep apnea (OSA) on COVID-19 infection outcome remains to be elucidated. However, the coincidence of common risk factors for OSA and severe COVID-19 suggests that patients with OSA receiving positive airway pressure therapy may have an advantage relative to those untreated when confronted with a COVID-19 infection. The ongoing COVID-19 pandemic has led to a substantial reduction of sleep medicine services, and the long-term consequences may be considerable. New strategies for the management of sleep disorders are needed to overcome the current underdiagnosis and delay of treatment.
Asunto(s)
COVID-19 , Pandemias , Apnea Obstructiva del Sueño , Medicina del Sueño , COVID-19/epidemiología , Humanos , Estudios Longitudinales , Sistema de Registros , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/terapia , Medicina del Sueño/estadística & datos numéricos , Suecia/epidemiologíaRESUMEN
Although it is widely acknowledged that there are not enough clinicians trained in either Behavioral Sleep Medicine (BSM) in general or in Cognitive Behavioral Therapy for Insomnia (CBT-I) in specific, what is unclear is whether this problem is more acute in some regions relative to others. Accordingly, a geographic approach was taken to assess this issue. Using national directories as well as e-mail listservs (Behavioral Sleep Medicine group and Behavioral Treatment for Insomnia Roster), the present study evaluated geographic patterning of CBSM and BSM providers by city, state, and country. Overall, 88% of 752 BSM providers worldwide live in the United States (n = 659). Of these, 58% reside in 12 states with ≥ 20 providers (CA, NY, PA, IL, MA, TX, FL, OH, MI, MN, WA, and CO), and 19% reside in just 2 states (NY and CA). There were 4 states with no BSM providers (NH, HI, SD, and WY). Of the 167 U.S. cities with a population of > 150,000, 105 cities have no BSM providers. These results clearly suggest that a targeted effort is needed to train individuals in both the unserved and underserved areas.
Asunto(s)
Medicina de la Conducta , Terapia Cognitivo-Conductual , Mapeo Geográfico , Área sin Atención Médica , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Medicina del Sueño/organización & administración , Medicina de la Conducta/organización & administración , Medicina de la Conducta/estadística & datos numéricos , Ciudades/estadística & datos numéricos , Terapia Cognitivo-Conductual/estadística & datos numéricos , Humanos , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Medicina del Sueño/estadística & datos numéricos , Estados Unidos/epidemiología , Recursos HumanosRESUMEN
PURPOSE: Nonallergic rhinitis (NAR) is a common condition involving symptomatic nasal congestion, stuffiness, or rhinorrhea, which overlap with symptoms of allergic rhinitis. Scant research has examined NAR and sleep. The aim of this study was to assess the frequency of potential NAR symptoms in a large sample of sleep center patients. METHODS: A retrospective chart review was conducted on 2658 adult patients at our sleep center from 2008 to 2012; 1703 reported clinically relevant nasal congestion. For this subset, potential NAR status (NAR+ vs NAR-) was determined using a brief survey. NAR groups were further divided into three sub-groups based on presenting chief complaints: insomnia (INS), nonrestorative sleep (NRS), and sleep-disordered breathing (SDB). Patients objectively diagnosed with SDB were also analyzed by NAR status. Validated scales for sleepiness, insomnia, anxiety, and depression were compared among the groups. RESULTS: Potential NAR+ comprised 70 % (1194 of 1703) of patients with congestion and showed significantly higher congestion scores than NAR- status [11.97 (3.62) vs 10.47 (3.37); p = .001; g = 0.42; 95 % CI, 0.32-0.53]. The proportion of potential NAR+ cases for each presenting chief complaint was nearly identical (range 69.6 to 71.2 %). However, the comparison of effects between NAR+ and NAR- cases within each presenting group (INS, NRS, SDB) was more consistently significant on the scales for insomnia, sleepiness, anxiety, and depression only in the SDB category. The same four symptoms, measured in those objectively diagnosed with SDB, were also significantly worse in NAR+ compared to NAR- patients. CONCLUSIONS: Regardless of presenting chief complaint and ultimate diagnosis of sleep-disordered breathing, potential nonallergic rhinitis was common in patients at a sleep medical center at a rate possibly greater than twice that reported in the general population. Potential NAR+ was associated with worse sleep and distress symptoms. In both prevalence and treatment studies, research must further evaluate the potential impact of NAR on specific sleep disorders.
Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Rinitis/epidemiología , Síndromes de la Apnea del Sueño/epidemiología , Medicina del Sueño/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obstrucción Nasal/epidemiología , Polisomnografía , Estudios RetrospectivosRESUMEN
OBJECTIVE: To measure the frequency of pharmacotherapeutic failure and its association with the diagnosis of sleep-disordered breathing among patients with chronic insomnia disorder. PATIENTS AND METHODS: In a retrospective review of medical records from January 1, 2005, through December 31, 2012, we identified an inclusive, consecutive series of 1210 patients with insomnia disorder, 899 (74.3%) of whom used sleep aids either occasionally (168 [18.7%]) or regularly (731 [81.3%]). Patients presented to a community-based sleep medicine center in Albuquerque, New Mexico, with typical referral patterns: 743 (61.4%) were referred by primary care physicians, 211 (17.4%) by specialists, 117 (9.7%) by mental health professionals, and 139 (11.5%) by self-referral. Pharmacotherapeutic failure was assessed from subjective insomnia reports and a validated insomnia severity scale. Polysomnography with pressure transducer (an advanced respiratory technology not previously used in a large cohort of patients with insomnia) measured sleep-disordered breathing. Objective data yielded accuracy rates for 3 pretest screening tools used to measure risk for sleep-disordered breathing. RESULTS: Of the total sample of 1210 patients, all 899 (74.3%) who were taking over-the-counter or prescription sleep aids had pharmacotherapeutic failure. The 710 patients taking prescription drugs (79.0%) reported the most severe insomnia, the fewest sleep-associated breathing symptoms, and the most medical and psychiatric comorbidity. Of the 942 patients objectively tested (77.9%), 860 (91.3%) met standard criteria, on average, for a moderate to severe sleep-associated breathing disorder, yet pretest screening sensitivity for sleep-disordered breathing varied widely from 63.7% to 100%. Positive predictive values were high (about 90%) for all screens, but a tool commonly used in primary care misclassified 301 patients (32.0% false-negative results). CONCLUSION: Pharmacotherapeutic failure and sleep-disordered breathing were extremely common among treatment-seeking patients with chronic insomnia disorder. Screening techniques designed from the field of sleep medicine predicted high rates for sleep-disordered breathing, whereas a survey common to primary care yielded many false-negative results. Although the relationship between insomnia and sleep-disordered breathing remains undefined, this research raises salient clinical questions about the management of insomnia in primary care before sleep center encounters.
Asunto(s)
Hipnóticos y Sedantes/uso terapéutico , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/uso terapéutico , Aceptación de la Atención de Salud/estadística & datos numéricos , Polisomnografía , Pronóstico , Estudios Retrospectivos , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Medicina del Sueño/métodos , Medicina del Sueño/estadística & datos numéricos , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Limited information is available regarding sleep medicine education worldwide. Nevertheless, medical education has been blamed for the under-recognition of sleep disorders among physicians. This study was designed to assess the knowledge of Saudi undergraduate medical students about sleep and sleep disorders and the prevalence of education on sleep medicine in medical schools as well as to identify the obstacles to providing such education. METHODS: We surveyed medical schools that were established more than 10 years ago, asking fourth- and fifth-year medical students (men and women) to participate. Seven medical schools were selected. To assess knowledge on sleep and sleep disorders, we used the Assessment of Sleep Knowledge in Medical Education (ASKME) Survey, which is a validated 30-item questionnaire. The participants were separated into two groups: those who scored ≥60% and those who scored <60%. To assess the number of teaching hours dedicated to sleep medicine in the undergraduate curricula, the organizers of the major courses on sleep disorders were contacted to obtain the curricula for those courses and to determine the obstacles to education. RESULTS: A total of 348 students completed the survey (54.9% male). Among the participants, 27.7% had a specific interest in sleep medicine. More than 80% of the study sample had rated their knowledge in sleep medicine as below average. Only 4.6% of the respondents correctly answered ≥60% of the questions. There was no difference in the scores of the respondents with regard to university, gender, grade-point average (GPA) or student academic levels. Only five universities provided data on sleep medicine education. The time spent teaching sleep medicine in the surveyed medical schools ranged from 0-8 hours with a mean of 2.6 ±2.6 hours. Identified obstacles included the following: (1) sleep medicine has a lower priority in the curriculum (53%) and (2) time constraints do not allow the incorporation of sleep medicine topics in the curriculum (47%). CONCLUSIONS: Medical students in the surveyed institutions possess poor knowledge regarding sleep medicine, which reflects the weak level of education in this field of medicine. To improve the recognition of sleep disorders among practicing physicians, medical schools must provide adequate sleep medicine education.
Asunto(s)
Medicina del Sueño/educación , Estudiantes de Medicina , Curriculum , Recolección de Datos , Educación de Pregrado en Medicina/organización & administración , Educación de Pregrado en Medicina/estadística & datos numéricos , Evaluación Educacional , Femenino , Humanos , Masculino , Arabia Saudita , Medicina del Sueño/estadística & datos numéricos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: Greece has entered a long period of economic crisis with adverse effects in daily life. The aim of our study was to evaluate the impact of the economic crisis on the population visiting a sleep clinic between years 2008 and 2011. METHODS: Comparison of the number of patients, anthropometric data, symptoms, and treatment between 2008 (beginning of crisis) to 2011(great impact of crisis) was conducted. RESULTS: The number of patients significantly reduced in 2011(n = 127) compared with that in 2008 (n = 463) and 2009 (n = 465). The mean age, body mass index, and Epworth Sleepiness Scale did not differ between the years (52.2 ± 13.7 years, 33 ± 7.4 kg/m(2), and 11.4 ± 5.4, respectively). The main symptom of the patients was daytime sleepiness, and the symptoms that worsened in 2011 compared with 2008 were headaches (32.4 vs. 49.6 %, p < 0.001) and nightmares (44 vs. 75.9 %, p < 0.001). In 2008, 69.1 % of patients required treatment for obstructive sleep apnea syndrome with continuous positive airway pressure (CPAP), and 81.6 % of them received CPAP. In 2011, 67.7 % required treatment, but only 52.3 % received CPAP. CONCLUSIONS: The economic crisis can be reflected in the number of patients, their symptoms and their treatment options.