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Sleep & Breathing

, Volume 2, Issue 1, pp 11–22 | Cite as

Sleep disordered breathing in primary care medicine

  • R. A. StoohsEmail author
  • K. Barger
  • W. C. Dement
Original Articies
  • 42 Downloads

Abstract

Primary care medicine plays a key role in the delivery of health care. Sleep disorders medicine is a new specialty and standard medical school curricula do not contain any or only very little training in sleep medicine. Unrecognized and therefore untreated sleep disorders account for a large loss of human life and socio-economic damage. Recognition of sleep disorders, in particular sleep-disordered breathing at the primary care level is thus a major element in health care delivery. The objective of this study was to assess the occurrence of the risk of sleep-disordered breathing (SDB) in a large primary care population. 852 primary care patients received a validated questionnaire which contained items based on signs and symptoms of SDB, periodic limb movement disorder (PLMD), and insomnia. A polygraphically validated algorithm was used to identify patients with a high suspicion of having sleep disordered breathing. Based on this algorithm 20% of the study participants had a high risk for SDB, 18.5% of PLMD and 25% of insomnia.

Most commonly daytime sleepiness and fatigue was associated in patients with a positive likelihood of SDB, PLMD, and insomnia. Fifty percent of all primary care patients reported to snore while 31% of snorers reported to snore every night. SDB was twice as common in men than in women and associated with a significantly higher body mass index. A popular validated scale to assess the degree of daytime sleepiness, the Epworth sleepiness scale, was not always useful to document the degree of daytime sleepiness.

We conclude that SDB, PLMD, and insomnia are very frequent sleep disorders in primary care patients yielding the need to include assessment of these sleep disorders in the medical history of primary care physicians.

Keywords

sleep disordered breathing primary care epidemiology 

Schlafbezogene Atmungsstörungen in der hausärztlichen Versorgung

Zusammenfassung

Die Primärversorgung spielt bei der medizinischen Versorgung der Bevölkerung eine Schlüsselrolle. Die Schlafmedizin stellt ein neues Spezialgebiet dar; sie findet keine oder nur wenig Berücksichtigung in den traditionellen Hochschul-Lehrplänen des Studienganges Medizin. Unerkannte - und daher unbehandelte- Schlafstörungen sind verantwortlich für den Verlust vieler Menschenleben und verursachen einen hohen sozio-ökonomischen Schaden. Die Erkennung von Schlafstörungen, insbesondere von schlafbezogenen Atmungsstörungen (sleep-disordered breathing - SDB) auf der Ebene der Primärversorgung ist daher von wesentlicher Bedeutung für die medizinische Versorgung der Bevölkerung. Ziel dieser Studie war, die Wahrscheinlichkeit des Auftretens von SDB in einer umfangreichen allgemeinmedizinischen Patientenpopulation zu bestimmen. 852 Patienten wurde ein validierter Fragebogen vorgelegt, dessen Fragen sich auf Anzeichen und Symptome von SDB, periodischen Bein- und Armbewegungen (periodic limb movement disorder: PLMD) und Insomnie bezogen. Mit Hilfe eines durch Polysomnographie validierten Algorithmus wurde untersucht, welche Patienten mit hoher Wahrscheinlichkeit unter einer schlafbezogenen Atmungsstörung litten. Auf der Grundlage dieses Algorithmus hatten 20% der an der Studie Beteiligten ein hohes SDB-Risiko, 18,5% ein hohes PLMD Risiko und 25% ein hohes Insomnie-Risiko.

In der Mehrheit der Fälle waren Tagesschläfrigkeit und müdigkeit mit einer hohen Wahrscheinlichkeit von SDB, PLMS und Insomnie assoziiert. Fünfzig Prozent aller Patienten gaben an, daß sie schnarchten, und 31% der Schnarcher gaben an, daß sie jede Nacht schnarchten. SDB war bei den Männern doppelt so häufig als bei den Frauen, und ging mit einem deutlich höheren Body Mass Index einher. Eine zur Beurteilung des Schweregrades der Tagesschläfrigkeit beliebte und validierte Skala, die Epworth Sleepiness Scale, erwies sich nicht in allen Fällen als nützlich, um den Schweregrad der Tagesschläfrigkeit zu belegen.

Schlüsselwörter

schlafbezogene Atmungsstörungen hausärztliche Versorgung Epidemiologie 

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References

  1. [1]
    Ancoli-lsrael S, Klauber MR, Kripke DF, Parker L, Cobarrubias M (1989) Sleep apnea in female patients in a nursing home. Increased risk of mortality. Chest 96: 1054–1058CrossRefGoogle Scholar
  2. [2]
    Ball R, Dement WCD et al (1997) Archives of Internal Medicine, in pressGoogle Scholar
  3. [3]
    Bliwise DL, Bliwise NG, Partinen M, Pursley AM, Dement NN (1988) Sleep apnea and mortality in an aged cohort. American Journal of Public Health 78: 544–547PubMedCrossRefGoogle Scholar
  4. [4]
    Boutros NN (1989) Headache in sleep apnea. Texas Medicine 85: 34–35PubMedGoogle Scholar
  5. [5J.
    Flemons WW, Whitelaw WA, Brant R, Remmers JE (1994) Likelihood ratios for a sleep apnea clinical prediction rule. American Journal of Respiratory & Critical Care Medicine 150: 1279–1285Google Scholar
  6. [6]
    Fletcher EC (1995) The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. American Journal of Medicine 98: 118–128PubMedCrossRefGoogle Scholar
  7. [7J.
    Guilleminault C, Eldridge FL, Tilkian A, Simmons FBD (1977) Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Archives of Internal Medicine 137: 296–300.PubMedCrossRefGoogle Scholar
  8. [8]
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  9. [9J.
    Johns MW(1992) Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 15: 376–381PubMedGoogle Scholar
  10. [10]
    Katsumata K, Okada T, Miyao M, Katsumata Y (1991) High incidence of sleep apnea syndrome in a male diabetic population. Diabetes Res Clin Pract 13:45–51PubMedCrossRefGoogle Scholar
  11. [11]
    Kump K, Whalen C, Tishler PV, Browner I, Ferrette VS, Rosenberg C, Redline S (1994) Assessment of the validity and utility of a sleep-symptom questionnaire. American Journal of Respiratory & Critical Care Medicine 150: 735–741Google Scholar
  12. [12]
    Lavie P, Merer P, Peled R, Berger I, Yoffe N, Zomer JR (1995) Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 18:149–157PubMedGoogle Scholar
  13. [13]
    Maislin G, Pack AI, Kribbs NB, Smith PL, Schwartz ARK, Schwab Rh, Dinges DF (1995) A survey screen for prediction of apnea. Sleep 18: 158–166PubMedGoogle Scholar
  14. [14]
    Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD (1991) Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. Chest 99: 861–866PubMedCrossRefGoogle Scholar
  15. [15]
    Partinen M (1991) Body mass index and neck circumference in obstructive sleep apnea. American Review of Respiratory Disease 143: 204PubMedGoogle Scholar
  16. [16]
    Roth T, Roehrs T, Kryger M (1990) Mortality in obstructive sleep apnea. Progress in Clinical & Biological Research 345: 347–351Google Scholar
  17. [17]
    Schmidt-Nowara WW, Coultas DB, Wiggins C, Skipper BES (1990) Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity. Archives of Internal Medicine 150: 597–601PubMedCrossRefGoogle Scholar
  18. [18]
    Stoohs R, Skrobal A, Guilleminault C (1993) Does snoring intensity predict flow limitation or respiratory effort during sleep? Respiration Physiology 92: 27–38PubMedCrossRefGoogle Scholar
  19. [19]
    Stoohs R, Guilleminault C, Dement WC (1995) A Model for home-based diagnosis of sleep-disordered breathing: Establishing pre-test probability. In: Biolac B, Paty J: Proceedings of the second international meeting on sleep disorders, Bordeaux, FranceGoogle Scholar
  20. [20]
    Stoohs RA, Bingham LA, Itoi A, Guilleminault C, Dement WC (1995) Sleep and sleep-disordered breathing in commercial long-haul truck drivers. Chest 107: 1275–1282PubMedCrossRefGoogle Scholar
  21. [21]
    Stoohs RA, Gingold J, Cohrs S, Harter R, Finlayson E, Guilleminault C (1996) Sleep disordered breathing and systemic hypertension in the elderly male. J Am Ger Soc 44: 1295–1300Google Scholar
  22. [22]
    Wiggins CL, Schmidt-Nowara WW, Coultas DB, Samet JM (1990) Comparison of self- and spouse reports of snoring and other symptoms associated with sleep apnea syndrome. Sleep 13: 245–252PubMedGoogle Scholar
  23. [23]
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. New England Journal of Medicine 328: 1230–1235PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  1. 1.Stanford University Medical SchoolStanford University Sleep Disorders and Research CenterStanford

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