Abstract
Despite the recognition of the importance of healthy sleep and the field of sleep medicine as its own subspecialty, the current sleep-specialty trained workforce is insufficient to meet the demands of the enormous population of patients who have a sleep disease. Re-centering the spotlight on patient-centered care requires reconsideration of the current model of care. We propose a patient-centered point of care model that facilitates the patient receiving the best possible care, in a convenient and timely manner, for their sleep complaints to promote sleep health which utilizes patient, provider, educational, and technological resources.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Shepard JW, Buysse DJ, Chesson AL, Dement WC, Goldberg R, Guilleminault C, et al. History of the development of sleep medicine in the United States. J Clin Sleep Med. 2005;1(1):61–82.
FREIDA. AMA program results 2021. Available from: https://freida.ama-assn.org/search/list?spec=43391%20Put%20out%20by%20the%20AMA.
American Board of Medical Specialties. ABMS board certification report 2021. Available from: https://www.abms.org/board-certification/abms-board-certification-report/.
Frost & Sullivan; American Academy of Sleep Medicine. Medicine Hidden health crisis costing America billions: underdiagnosing and undertreating obstructive sleep apnea draining health care system. 2016. Available from: http://aasm.org/wp-content/uploads/2017/10/sleep-apnea-economic-crisis.pdf.
Quan SF. Graduate medical education in sleep medicine: did the canary just die? J Clin Sleep Med. 2013;09(02):101–2.
Billings ME, Cohen RT, Baldwin CM, Johnson DA, Palen BN, Parthasarathy S, et al. Disparities in sleep health and potential intervention models: a focused review. Chest. 2021;159(3):1232–40.
Owens J. Introduction to special section: NIH sleep academic award program. Sleep Med. 2005;6(1):45–6.
Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG, et al. Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial. JAMA. 2013;309(10):997–1004.
Sánchez-de-la-Torre M, Nadal N, Cortijo A, Masa JF, Duran-Cantolla J, Valls J, et al. Role of primary care in the follow-up of patients with obstructive sleep apnoea undergoing CPAP treatment: a randomised controlled trial. Thorax. 2015;70(4):346.
Sánchez-Quiroga MÁ, Corral J, Gómez-de-Terreros FJ, Carmona-Bernal C, Asensio-Cruz MI, Cabello M, et al. Primary care physicians can comprehensively manage patients with sleep apnea. A noninferiority randomized controlled trial. Am J Respir Crit Care Med. 2018;198(5):648–56.
Tarraubella N, Sánchez-de-la-Torre M, Nadal N, De Batlle J, Benítez I, Cortijo A, et al. Management of obstructive sleep apnoea in a primary care vs sleep unit setting: a randomised controlled trial. Thorax. 2018;73(12):1152.
Fuller JM, Wong KK, Grunstein R, Krass I, Patel J, Saini B. A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial. PLoS One. 2014;9(6):e101003.
Perraudin C, Fleury B, Pelletier-Fleury N. Effectiveness of intervention led by a community pharmacist for improving recognition of sleep apnea in primary care – a cohort study. J Sleep Res. 2015;24(2):167–73.
Rosen IM, Rowley JA, Malhotra RK, Kristo DA, Carden KA, Kirsch DB. Strategies to improve patient care for obstructive sleep apnea: a report from the American Academy of Sleep Medicine Sleep-Disordered Breathing Collaboration Summit. J Clin Sleep Med. 2020;16(11):1933–7.
Brennan T. A new approach to sleep apnea 2021. Available from: https://payorsolutions.cvshealth.com/insights/new-approach-sleep-apnea.
Espie CA, MacMahon KMA, Kelly H-L, Broomfield NM, Douglas NJ, Engleman HM, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep. 2007;30(5):574–84.
Bothelius K, Kyhle K, Espie CA, Broman JE. Manual-guided cognitive-behavioural therapy for insomnia delivered by ordinary primary care personnel in general medical practice: a randomized controlled effectiveness trial. J Sleep Res. 2013;22(6):688–96.
Chai-Coetzer CL, Antic NA, McEvoy RD. Identifying and managing sleep disorders in primary care. Lancet Respir Med. 2015;3(5):337–9.
Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7(2):123–30.
The Physicians Foundation. The Physicians Foundation 2016 Physician Survey 2016. Available from: http://www.physiciansfoundation.org/healthcare-research/physiciansurvey.
Sandlund C, Hetta J, Nilsson GH, Ekstedt M, Westman J. Improving insomnia in primary care patients: a randomized controlled trial of nurse-led group treatment. Int J Nurs Stud. 2017;72:30–41.
Morgenthaler TI, Owens J, Alessi C, Boehlecke B, Brown TM, Coleman J Jr, et al. Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006;29(10):1277–81.
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–33.
Rios P, Cardoso R, Morra D, Nincic V, Goodarzi Z, Farah B, et al. Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews. Syst Rev. 2019;8(1):281.
Koffel E, Bramoweth AD, Ulmer CS. Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med. 2018;33(6):955–62.
Maire M, Linder S, Dvořák C, Merlo C, Essig S, Tal K, et al. Prevalence and management of chronic insomnia in Swiss primary care: cross-sectional data from the “Sentinella” practice-based research network. J Sleep Res. 2020;29(5):e13121.
Ulmer CS, Bosworth HB, Beckham JC, Germain A, Jeffreys AS, Edelman D, et al. Veterans affairs primary care provider perceptions of insomnia treatment. J Clin Sleep Med. 2017;13(8):991–9.
Davy Z, Middlemass J, Siriwardena AN. Patients’ and clinicians’ experiences and perceptions of the primary care management of insomnia: qualitative study. Health Expect. 2015;18(5):1371–83.
Cheung JM, Atternäs K, Melchior M, Marshall NS, Fois RA, Saini B. Primary health care practitioner perspectives on the management of insomnia: a pilot study. Aust J Prim Health. 2014;20(1):103–12.
Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171(10):887–95.
Smallheer BA. Evaluation and treatment of restless legs syndrome in the primary care environment. Nurs Clin North Am. 2018;53(3):433–45.
Donovan LM, Yu L, Bertisch SM, Buysse DJ, Rueschman M, Patel SR. Responsiveness of patient-reported outcomes to treatment among patients with type 2 diabetes mellitus and OSA. Chest. 2020;157(3):665–72.
Espie CA. “Stepped care”: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep. 2009;32(12):1549–58.
Sweetman A, Lack L, Catcheside PG, Antic NA, Smith S, Chai-Coetzer CL, et al. Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial. Sleep. 2019;42(12):zsz178.
Sweetman AM, Lack LC, Catcheside PG, Antic NA, Chai-Coetzer CL, Smith SS, et al. Developing a successful treatment for co-morbid insomnia and sleep apnoea. Sleep Med Rev. 2017;33:28–38.
Watson NF, Rosen IM, Chervin RD. The past is prologue: the future of sleep medicine. J Clin Sleep Med. 2017;13(1):127–35.
Pendharkar S, Blades K, Kelly J, et al. Perspectives on primary care management of obstructive sleep apnea: a qualitative study of patients and health care providers. J Clin Sleep Med. 2021;17(1):89–98.
Stevenson L, Ball S, Haverhals LM, Aron DC, Lowery J. Evaluation of a national telemedicine initiative in the Veterans Health Administration: factors associated with successful implementation. J Telemed Telecare. 2018;24(3):168–78.
Su GL, Glass L, Tapper EB, Van T, Waljee AK, Sales AE. Virtual consultations through the veterans administration SCAN-ECHO project improves survival for veterans with liver disease. Hepatology. 2018;68(6):2317–24.
Guzman-Clark J, Harrell K, Leff A, Henriques D, Ines E, Rofail M, et al. Implementation of an ECHO-based program to provide geriatric specialty care consultation and education to remote primary care teams. Fed Pract. 2016;33(4):40–5.
Ball S, Wilson B, Ober S, McHaourab A. SCAN-ECHO for pain management: implementing a regional telementoring training for primary care providers. Pain Med. 2018;19(2):262–8.
Parsons EC, Mattox EA, Beste LA, Au DH, Young BA, Chang MF, et al. Development of a sleep telementorship program for rural Department of Veterans Affairs primary care providers: sleep veterans affairs extension for community healthcare outcomes. Ann Am Thorac Soc. 2017;14(2):267–74.
Smith AG. A sleep medicine medical school curriculum: time for us to wake up. Neurology. 2018;91(13):587–8.
Salas RE, Gamaldo A, Collop NA, Gulyani S, Hsu M, David PM, et al. A step out of the dark: improving the sleep medicine knowledge of trainees. Sleep Med. 2013;14(1):105–8.
Salas RME, Strowd RE, Ali I, Soni M, Schneider L, Safdieh J, et al. Incorporating sleep medicine content into medical school through neuroscience core curricula. Neurology. 2018;91(13):597–610.
Lam AS, Wise SK, Dedhia RC. Practice patterns of sleep otolaryngologists at training institutions in the United States. Otolaryngol Head Neck Surg. 2017;156(6):1025–31.
Cass N, Kominsky A, Cabrera-Muffly C. Otolaryngology sleep medicine curriculum objectives as determined by sleep experts. Am J Otolaryngol. 2017;38(2):139–42.
Avidan AY, Vaughn BV, Silber MH. The current state of sleep medicine education in US neurology residency training programs: where do we go from here? J Clin Sleep Med. 2013;9(3):281–6.
American Board of Internal Medicine. Pulmonary disease certification examination blueprint 2021. Available from: https://www.abim.org/~/media/ABIM%20Public/Files/pdf/exam-blueprints/certification/pulmonary-disease.pdf.
Schulman DA, Piquette CA, Alikhan MM, Freedman N, Kumar S, McCallister J, et al. A sleep medicine curriculum for pulmonary and pulmonary/critical care fellowship programs: a multisociety expert panel report. Chest. 2019;155(3):554–64.
Mehra R, Rosen IM. Clarifying requisite sleep medicine content for the pulmonary and critical care medicine fellow: a key step forward, but where do we go from here? Chest. 2019;155(3):460–2.
Namen AM, Wymer A, Case D, Haponik EF. Performance of sleep histories in an ambulatory medicine clinic: impact of simple chart reminders. Chest. 1999;116(6):1558–63.
Sepucha KR, Simmons LH, Barry MJ, Edgman-Levitan S, Licurse AM, Chaguturu SK. Ten years, forty decision aids, and thousands of patient uses: shared decision making at Massachusetts General Hospital 2016. Available from: https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1376.
Maguire E, Hong P, Ritchie K, Meier J, Archibald K, Chorney J. Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing. J Otolaryngol Head Neck Surg. 2016;45(1):57.
Fung CH, Martin JL, Liang LJ, Hays RD, Col N, Patterson ES, et al. Efficacy of a patient decision aid for improving person-centered decision-making by older adults with obstructive sleep apnea. J Clin Sleep Med. 2021;17(2):121–8.
Chai-Coetzer CL, Antic NA, Rowland LS, Catcheside PG, Esterman A, Reed RL, et al. A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care. Thorax. 2011;66(3):213–9.
Epton MJ, Kelly PT, Shand BI, Powell SV, Jones JN, McGeoch GRB, et al. Development and outcomes of a primary care-based sleep assessment service in Canterbury, New Zealand. NPJ Prim Care Respir Med. 2017;27(1):26.
McPherson CJ, Higginson IJ, Hearn J. Effective methods of giving information in cancer: a systematic literature review of randomized controlled trials. J Public Health Med. 2001;23(3):227–34.
Mills ME, Sullivan K. The importance of information giving for patients newly diagnosed with cancer: a review of the literature. J Clin Nurs. 1999;8(6):631–42.
Saunders CH, Petersen CL, Durand MA, Bagley PJ, Elwyn G. Bring on the machines: could machine learning improve the quality of patient education materials? A systematic search and rapid review. JCO Clin Cancer Inform. 2018;2:1–16.
Luyster FS, Choi J, Yeh CH, Imes CC, Johansson AE, Chasens ER. Screening and evaluation tools for sleep disorders in older adults. Appl Nurs Res. 2015;28(4):334–40.
Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631–8.
Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, et al. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10(12):e0143697.
Tan A, Yin JD, Tan LW, van Dam RM, Cheung YY, Lee CH. Predicting obstructive sleep apnea using the STOP-Bang questionnaire in the general population. Sleep Med. 2016;27-28:66–71.
Martin JL, Song Y, Hughes J, Jouldjian S, Dzierzewski JM, Fung CH, et al. A four-session sleep intervention program improves sleep for older adult day health care participants: results of a randomized controlled trial. Sleep. 2017;40(8):zsx079.
Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165(11):1286–92.
Ferri R, Lanuzza B, Cosentino FI, Iero I, Tripodi M, Spada RS, et al. A single question for the rapid screening of restless legs syndrome in the neurological clinical practice. Eur J Neurol. 2007;14(9):1016–21.
Nichols DA, Allen RP, Grauke JH, Brown JB, Rice ML, Hyde PR, et al. Restless legs syndrome symptoms in primary care: a prevalence study. Arch Intern Med. 2003;163(19):2323–9.
Walters AS, Frauscher B, Allen R, Benes H, Chaudhuri KR, Garcia-Borreguero D, et al. Review of diagnostic instruments for the restless legs syndrome/Willis-Ekbom Disease (RLS/WED): critique and recommendations. J Clin Sleep Med. 2014;10(12):1343–9.
Harrison JD, Patel MS. Designing nudges for success in health care. AMA J Ethics. 2020;22(9):E796–801.
Klingman KJ, Jungquist CR, Perlis ML. Questionnaires that screen for multiple sleep disorders. Sleep Med Rev. 2017;32:37–44.
Sarmiento KF, Folmer RL, Stepnowsky CJ, Whooley MA, Boudreau EA, Kuna ST, et al. National expansion of sleep telemedicine for veterans: the TeleSleep program. J Clin Sleep Med. 2019;15(9):1355–64.
Senthilvel E, Auckley D, Dasarathy J. Evaluation of sleep disorders in the primary care setting: history taking compared to questionnaires. J Clin Sleep Med. 2011;07(01):41–8.
Hwang D, Woodrum R. Inadequacy of current solutions to address provider shortage. Chest J. 2020;157(5):1055–7.
Goldstein CA, Berry RB, Kent DT, Kristo DA, Seixas AA, Redline S, et al. Artificial intelligence in sleep medicine: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2020;16(4):605–7.
Keenan BT, Kim J, Singh B, Bittencourt L, Chen NH, Cistulli PA, et al. Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep. 2018;41(3):zsx214.
Kim J, Keenan BT, Lim DC, Lee SK, Pack AI, Shin C. Symptom-based subgroups of Koreans with obstructive sleep apnea. J Clin Sleep Med. 2018;14(3):437–43.
Mazzotti DR, Keenan BT, Lim DC, Gottlieb DJ, Kim J, Pack AI. Symptom subtypes of obstructive sleep apnea predict incidence of cardiovascular outcomes. Am J Respir Crit Care Med. 2019;200(4):493–506.
Eckert DJ. Phenotypic approaches to obstructive sleep apnoea – new pathways for targeted therapy. Sleep Med Rev. 2018;37:45–59.
McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–31.
Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunström E. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. The RICCADSA randomized controlled trial. Am J Respir Crit Care Med. 2016;194(5):613–20.
Zinchuk A, Yaggi HK. Sleep apnea heterogeneity, phenotypes, and cardiovascular risk. Implications for trial design and precision sleep medicine. Am J Respir Crit Care Med. 2019;200(4):412–3.
Johns MW. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res. 2000;9(1):5–11.
Stephansen JB, Olesen AN, Olsen M, Ambati A, Leary EB, Moore HE, et al. Neural network analysis of sleep stages enables efficient diagnosis of narcolepsy. Nat Commun. 2018;9(1):5229.
Kuna ST. The MISSION act: challenges to sleep medicine and other specialties in the veterans health administration. Am J Respir Crit Care Med. 2019;200(6):663–4.
Health Resources & Services Administration. Telehealth programs 2021. Available from: https://www.hrsa.gov/rural-health/telehealth.
The Federation of State Medical Boards. House of delegates annual business meeting 2018. Available from: https://www.fsmb.org/siteassets/annual-meeting/hod/april-28-2018-fsmb-hod-book.pdf.
Kelly JM, Schwamm LH, Bianchi MT. Sleep telemedicine: a survey study of patient preferences. ISRN Neurol. 2012;2012:135329.
Johnson KG, Sullivan SS, Nti A, Rastegar V, Gurubhagavatula I. The impact of the COVID-19 pandemic on sleep medicine practices. J Clin Sleep Med. 2021;17(1):79–87.
Singh J, Badr MS, Diebert W, Epstein L, Hwang D, Karres V, et al. American Academy of Sleep Medicine (AASM) position paper for the use of telemedicine for the diagnosis and treatment of sleep disorders. J Clin Sleep Med. 2015;11(10):1187–98.
The Center for Connected Health Policy. Current state laws & reimbursement policies 2021. Available from: https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies.
Centers for Medicare & Medicaid Services. Medicare telemedicine health care provider fact sheet 2020. Available from: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.
Mehrotra A, Nimgaonkar A, Richman B. Telemedicine and medical licensure — potential paths for reform. N Engl J Med. 2021;384(8):687–90.
Fields BG, Behari PP, McCloskey S, True G, Richardson D, Thomasson A, et al. Remote ambulatory management of veterans with obstructive sleep apnea. Sleep. 2016;39(3):501–9.
Parikh R, Touvelle MN, Wang H, Zallek SN. Sleep telemedicine: patient satisfaction and treatment adherence. Telemed J E Health. 2011;17(8):609–14.
Aurora RN, Collop NA, Jacobowitz O, Thomas SM, Quan SF, Aronsky AJ. Quality measures for the care of adult patients with obstructive sleep apnea. J Clin Sleep Med. 2015;11(3):357–83.
Arnedt JT, Conroy DA, Mooney A, Furgal A, Sen A, Eisenberg D. Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial. Sleep. 2021;44(1):zsaa136.
American Academy of Sleep Medicine. Download the sleep telemedicine implementation guide – a FREE resource from AASM 2021 [February 28, 2021]. Available from: https://aasm.org/download-the-sleep-telemedicine-implementation-guide-a-free-resource-from-aasm/.
Goldstein C. Current and future roles of consumer sleep technologies in sleep medicine. Sleep Med Clin. 2020;15(3):391–408.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Fields, B.G., Rosen, I.M. (2022). The Future of Sleep Medicine: A Patient-Centered Model of Care. In: Badr, M.S., Martin, J.L. (eds) Essentials of Sleep Medicine. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-93739-3_4
Download citation
DOI: https://doi.org/10.1007/978-3-030-93739-3_4
Published:
Publisher Name: Humana, Cham
Print ISBN: 978-3-030-93738-6
Online ISBN: 978-3-030-93739-3
eBook Packages: MedicineMedicine (R0)