Advertisement

Sleep Disorders in Primary Care

Evidence-Based Clinical Practice
  • James F. Pagel
Part of the Current Clinical Practice book series (CCP)

Abstract

Each of us spend one-third of our lives asleep. Dysfunctions in this basic state lead to declines in quality of life, diminished waking performance, more frequent illness, and increases in both morbidity and mortality. Recent epidemiological data have emphasized the significant contribution of obstructive sleep apnea (OSA), one of the most physiological disruptive and dangerous sleep-related diagnosis, to pulmonary, cardiac, endocrine, and cognitive diseases (1–4). Yet sleep medicine is not just a pulmonary subspecialty. The spectrum of sleep disorders mirrors the clinical population of patients in a broad-based practice of primary care (5) (Table 1). Almost all chronic diseases result in physical or mental discomfort for the patient and consistently induce disturbances in the state of sleep.

Keywords

Obstructive Sleep Apnea Sleep Apnea Sleep Disorder Obstructive Sleep Apnea Syndrome Sleep Medicine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gami AS, Caples SM, Somers VK (2003) Obesity and obstructive sleep apnea. Endocrinol Metab Clin North Am 32(4):869–894.PubMedCrossRefGoogle Scholar
  2. 2.
    Kenchaiah S, Narula J, Vasan RS (2004) Risk factors for heart failure. Med Clin North Am 88(5):1145–1172.PubMedCrossRefGoogle Scholar
  3. 3.
    Richert A, Ansarin K, Baran AS (2002) Sleep apnea and hypertension: pathophysiologic mechanisms. Semin Nephrol 22(l):71–77.PubMedGoogle Scholar
  4. 4.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9): 1217–1239.PubMedCrossRefGoogle Scholar
  5. 5.
    American Academy of Sleep Medicine, the International Classification of Sleep Disorders: Diagnostic and Coding Manual — 2nd edition, American Academy of Sleep Medicine, Westchester,IL, 2006.Google Scholar
  6. 6.
    Ancoli-Israel S, Roth T (1999) Characteristics of insomnia in the United States: Results of the 1991 National Sleep Foundation Survey. Sleep 22(Suppl 2):S347–S353.PubMedGoogle Scholar
  7. 7.
    Shochat T, Umphress J, Israel AG, Ancoli-Israel S (1999) Insomnia in primary care patients. Sleep 22(Suppl 2):S359–S365.PubMedGoogle Scholar
  8. 8.
    Chervin R, Archbold K, Panachi P, Pituch K (2001) Sleep problems seldom addressed at two general pediatric clinics. Pediatrics 107(6): 1375–1380.PubMedCrossRefGoogle Scholar
  9. 9.
    NIH State of the Science conference Statement, Bethesda, MD 2005.Google Scholar
  10. 10.
    Walsh JK, Engelhardt CL (1999) The direct economic costs of insomnia in the United States for 1995. Sleep 22(Suppl 2):S386–S393.PubMedGoogle Scholar
  11. 11.
    National Center on Sleep Disorders Research, National Heart Lung and Blood Institute, and National Institutes of Health (1999) Insomnia: assessment and management in primary care. Sleep 22(Suppl 2): S402–S408.Google Scholar
  12. 12.
    Roth T, Roehers TA (2000) Treating Insomnia in the Primary Care Setting: National Sleep Foundation Monograph, Washington, DC.Google Scholar
  13. 13.
    Benca RM (2001) Consequences of insomnia and its therapies. J Clin Psychiatry 62(Suppl 10): 33–38.PubMedGoogle Scholar
  14. 14.
    Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39(Suppl 6):411–418.PubMedCrossRefGoogle Scholar
  15. 15.
    Hasler G, Buysse DJ, Klaghofer R, et al. (2004) The association between short sleep duration and obesity in young adults: a 13-year prospective study. Sleep 27:661–666.PubMedGoogle Scholar
  16. 16.
    Roehrs TA, Blaisdell B, Greenwald MK, Roth T (2003) Pain threshold and sleep loss. Sleep 26(Suppl): A196.Google Scholar
  17. 17.
    Balter MB, Uhlenhuth EH (1992) New epidemiologic findings about insomnia and its treatment. J Clin Psychiatry 53(Suppl):34–39.PubMedGoogle Scholar
  18. 18.
    Chesson AL Jr, Anderson WM, Littner M, et al. (1999) Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 22:1128–1133.PubMedGoogle Scholar
  19. 19.
    Chesson AL Jr, Hartse K, Anderson WM, et al. (2000) Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine Report. Standards of Practice Committee of American Academy of Sleep Medicine. Sleep 23:237–241.PubMedGoogle Scholar
  20. 20.
    Thorpy M, Chesson A, Kader G, et al. (1995) Practice parameters for the use of polysomnography in the evaluation of insomnia. Standards of Practice Committee of the American Sleep Disorders Association. Sleep 18(1):55–57.Google Scholar
  21. 21.
    Stoller MK (1994) Economic effects of insomnia. Clin Ther 16:873–997.PubMedGoogle Scholar
  22. 22.
    Ebell MH, Siwek J, Weiss BD, et al. (2004) Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 69:549–557.Google Scholar
  23. 23.
    Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J (1999) The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 340(Suppl 11):847–851.PubMedCrossRefGoogle Scholar
  24. 24.
    Smith R, Ronald J, Delaive K, Walld R, Manfreda J, Kryger M (2002) What are obstructive sleep apnea patients being treated for Prior to this diagnosis? Chest 121:164–172.PubMedCrossRefGoogle Scholar
  25. 25.
    Wolk R, Shamsuzzaman AS, Somers VK (2003) Obesity, sleep apnea, and hypertension. Hypertension 42(6): 1067–1074.PubMedCrossRefGoogle Scholar
  26. 26.
    Vgontzas AN, Bixler EO (2003) Chrousos GP Metabolic disturbances in obesity versus sleep apnea: the importance of visceral obesity and insulin resistance. J Intern Med 254(l):32–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Verrier R, Josephson M Cardiac Arrhythmias and Sudden Death During Sleep, in Sleep: A Comprehensive Handbook (Lee-Chiong T, ed.) Wiley-Liss, Hoboken, NJ, 2006, pp. 727–732.Google Scholar
  28. 28.
    Gozal D (1998) Sleep-disordered breathing and school performance in children. Pediatrics 102:616–620.PubMedCrossRefGoogle Scholar
  29. 29.
    Pagel JF, Snyder S, Dawson D (2004) Obstructive Sleep Apnea in Sleepy Pediatric Psychiatry Clinic Patients: Polysomnographic and Clinical Correlates. Sleep Breathing 8(3):125–131.PubMedCrossRefGoogle Scholar
  30. 30.
    Kapur V, Blough DK, Sandblom RE, et al. (1999) The medical cost of undiagnosed sleep apnea. Sleep 22(Suppl 6):749–755.PubMedGoogle Scholar
  31. 31.
    Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Kryger MH (1999) Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment. Sleep 22(Suppl 6):740–747.PubMedGoogle Scholar
  32. 32.
    Peker Y, Hedner J, Johansson A, Bende M (1997) Reduced hospitalization with cardiovascular and pulmonary disease in obstructive sleep apnea patients on nasal CPAP treatment. Sleep 20:645–653.PubMedGoogle Scholar
  33. 33.
    Tarasiuk A, Simon T, Tal A, Reuveni H (2002) Adenotonsillectomy in children with obstructive sleep apnea syndrome reduces health care utilization. Pediatrics 110:68–72.PubMedCrossRefGoogle Scholar
  34. 34.
    Ronald J, Delaive K, Roos I, Manfreda J, Bahammam A, Kryger MH (1999) Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients. Sleep 22(2):225–229.PubMedGoogle Scholar
  35. 35.
    National Highway Traffic Safety Administration, http://www.nhtsa.dot.gov. Accessed October 2006.
  36. 36.
    Littner MR, Kushida C, Wise M, et al. (2005) Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep 28(1): 113–121.PubMedGoogle Scholar
  37. 37.
    Mahowald M (2000) Parasomnias. in: Principles and Practice of Sleep Medicine 3rd editions (Kryger M, Roth T, Dement W, eds.) W. B. Saunders Company, Philadelphia, pp. 693–796.Google Scholar
  38. 38.
    Littner MR, Kushida C, Anderson WM, et al. (2004) Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep 27(3):557–559.PubMedGoogle Scholar
  39. 39.
    Thorpy M, Ehrenberg BL, Hening WA, et al. (2000) Restless Legs Syndrome: Detection and Management in Primary Care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome. Am Academy Fam Physician 62(Suppl l):108–114.Google Scholar
  40. 40.
    Chesson AL Jr, Wise M, Davila D, et al. (1999) Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder. An American Academy of Sleep Medicine Report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 22(7):961–968.PubMedGoogle Scholar
  41. 41.
    Chesson AL, Ferber RA, Fry JM, et al. (1997) The indications for polysomnography and related procedures. Sleep 20:423–485.PubMedGoogle Scholar
  42. 42.
    Chesson A, Ferber R, Fry J, et al. (1997) Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep 20(6):406–422.Google Scholar
  43. 43.
    Kushida CA, Littner MR, Hirshkowitz M, et al. (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380.PubMedGoogle Scholar
  44. 44.
    Ferber R, Millman R, Coppola M, et al. (1994) Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep 17(4):378–379.PubMedGoogle Scholar
  45. 45.
    Thorpy M, Chesson A, Ferber R, et al. (1994) Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association. Sleep 17(4):372–377.Google Scholar
  46. 46.
    Littner M, Hirshkowitz M, Davila D, et al. (2002) Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. An American Academy of Sleep Medicine report. Sleep 25(2): 143–147.PubMedGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

Authors and Affiliations

  • James F. Pagel
    • 1
  1. 1.Department of Family PracticeUniversity of Colorado School of Medicine, Southern Colorado Family Medicine ResidencyPueblo

Personalised recommendations