A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial (original) (raw)
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The development of a sleep disorder screening program in Australian community pharmacies
Pharmacy World & Science, 2009
Objective To develop, pilot and determine the feasibility of a sleep-specific screening and awareness program in community pharmacies. Setting The screening was piloted in five Australian community pharmacies. Method The Pharmacy Tool for Assessment of Sleep Health was constructed by drawing on known relationships between sleep disorders, and lifestyle factors, medical conditions and medications. Four validated instruments were used in the screening tool: the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Multivariable Apnea Prediction Index (MAPI) and International Restless Legs Syndrome Study Group Screening Criteria (IRLS). These instruments were used to predict the participant's risk of a sleep disorder and the results were compared with reported lifestyle, medical and medication factors. On-site training of consenting pharmacists was provided, followed by an eight week client recruiting and screening period. Feedback was elicited from participating pharmacists and clients. Main outcome measure The feasibility of, and trends found from, the developed screening tool and protocol. Results Of 167 clients who requested or were invited to participate by pharmacists, 84 (50.3%) were screened. Analysis of collected data indicated that 33.3%, 21.4% and 27.4% of participants were at risk of having or developing insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS) respectively, while 38.1% were not at risk of any of the screened disorders. OSA odds increased 12.8 times (95% CI: 3.2-50.4) with diabetes and 4.9 times (1.2-20.9) with opioid use, while shift workers were 8.4 times (1.6-43.2) more likely to have insomnia. Participants and pharmacists reported the screening protocol and instrument was user friendly and feasible. Conclusion The development and pilot of this screening tool was successful. The prevalence of sleep disorders in the sampled population was high but generally consistent with previous studies on the general population. Furthermore, associations found may form a foundation for a clinical algorithm to identify those at a higher risk of having or developing a sleep disorder. Further work is required to validate this screening tool in the community pharmacy context.
Integrated Pharmacy Research and Practice, 2012
Background: When experiencing sleep problems for the first time, consumers may often approach community pharmacists for advice as they are easily accessible health care professionals in the community. In Australian community pharmacies there are no specific tools available for use by pharmacists to assist with the assessment and handling of consumers with sleep enquiries. Objective: To assess the feasibility of improving the detection of sleep disorders within the community through the pilot of a newly developed Community Pharmacy Sleep Assessment Tool (COP-SAT). Method: The COP-SAT was designed to incorporate elements from a number of existing, standardized, and validated clinical screening measures. The COP-SAT was trialed in four Australian community pharmacies over a 4-week period. Key findings: A total of 241 community pharmacy consumers were assessed using the COP-SAT. A total of 74 (30.7%) were assessed as being at risk of insomnia, 26 (10.7%) were at risk of daytime sleepiness, 19 (7.9%) were at risk of obstructive sleep apnea, and 121 (50.2%) were regular snorers. A total of 116 (48.1%) participants indicated that they consume caffeine before bedtime, of which 55 (47%) had associated symptoms of sleep onset insomnia. Moreover, 85 (35%) consumed alcohol before bedtime, of which 50 (58%) experienced fragmented sleep, 50 (58%) were regular snorers, and nine (10.6%) had apnea symptoms. The COP-SAT was feasible in the community pharmacy setting. The prevalence of sleep disorders in the sampled population was high, but generally consistent with previous studies on the general population. Conclusion: A large proportion of participants reported sleep disorder symptoms, and a link was found between the consumption of alcohol and caffeine substances at bedtime and associated symptoms. While larger studies are needed to assess the clinical properties of the tool, the results of this feasibility study have demonstrated that the COP-SAT may be a practical tool for the identification of patients at risk of developing sleep disorders in the community.
Adapting the Auckland Sleep Screening Tool for pharmacy: pharmacists’ experience and feedback
Journal of Primary Health Care, 2019
INTRODUCTIONInsomnia has negative health effects and may indicate underlying serious conditions, but is underdiagnosed and often not discussed with a doctor. AIMThis study aimed to explore the utility and workability in New Zealand community pharmacies of a 23-question sleep-screening tool adapted from the Short Auckland Sleep Questionnaire. METHODSA multidisciplinary advisory group (sleep specialist, general practitioner and pharmacists) discussed the tool, pharmacists’ capability in managing insomnia and training needs for pharmacists, and recommended management strategies, including referral points. Twelve community pharmacists piloted the tool with people with insomnia who presented in pharmacies, recording the time it took to administer the tool. The pharmacists were then surveyed about their experiences with the tool and possible improvements. RESULTSTen pharmacists took an average of 12.4 min (range 4–35 min) for each use of the screening tool with 62 people with insomnia. Mo...
BMC Health Services Research, 2014
Background: Sleep disorders are very common in the community and are estimated to affect up to 45% of the world's population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are-(1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders, (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders and (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design: This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion: This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow. Trial registration: Australian New Zealand Clinical Trial Registry: ACTRN12612000825853
Thorax, 2011
Background To address the growing burden of disease and long waiting lists for sleep services, a simplified twostage model was developed and validated for identifying obstructive sleep apnoea (OSA) in primary care using a screening questionnaire followed by home sleep monitoring. Methods 157 patients aged 25e70 years attending their primary care physician for any reason at six primary care clinics in rural and metropolitan regions of South Australia participated. The first 79 patients formed the development group and the next 78 patients the validation group. A screening questionnaire was developed from factors identified from sleep surveys, demographic and anthropometric data to be predictive of moderate to severe OSA. Receiver operating characteristic (ROC) curve analysis was used to validate the two-channel ApneaLink device against full polysomnography. The diagnostic accuracy of the overall two-stage model was then evaluated. Results Snoring, waist circumference, witnessed apnoeas and age were predictive of OSA and incorporated into a screening questionnaire (ROC area under curve (AUC) 0.84, 95% CI 0.75 to 0.94, p<0.001). ApneaLink oximetry with a 3% dip rate was highly predictive of OSA (AUC 0.96, 95% CI 0.91 to 1.0, p<0.001). The two-stage diagnostic model showed a sensitivity of 0.97 (95% CI 0.81 to 1.00) and specificity of 0.87 (95% CI 0.74 to 0.95) in the development group, and a sensitivity of 0.88 (95% CI 0.60 to 0.98) and specificity of 0.82 (95% CI 0.70 to 0.90) in the validation group. Conclusion A two-stage model of screening questionnaire followed by home oximetry can accurately identify patients with OSA in primary care and has the potential to expedite care for patients with this common sleep disorder.
Pharmacy Practice (Internet), 2013
The study aimed to document the state of insomnia management at community pharmacies in Pakistan. Methods: A cross-sectional study was conducted at randomly selected 371 pharmacies in three cities of Pakistan. Simulated patient visits were performed to collect information on case management of insomnia in terms of history taking and patient counseling at community pharmacies. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis and Mann Whitney tests (p<0.05) were performed to find out differences. Results: The patients were mainly handled by salesman 83.8% (n=311), by pharmacist 3.5% (n=13) and pharmacy assistants 12.7% (n=47). The mean dispensing time was 1.11 minutes (SD=5.61) with the range of 0.5 -6 minutes. Of the 371 simulated patients who visited the pharmacies, 72.8% (n=270) subjects were given medicines and 24.3% (n=90) subjects were referred to the doctor for treatment of insomnia. 61.8% (n=193) of the subjects were given benzodiazepines, 35.6% (n=111) antihistamines and 2.6% (n=8) NSAIDs at community pharmacies in the three cities. The mean cost of treatment in case of insomnia was PKR12.7 (SD=10.13, median=10).
Detection and screening of obstructive sleep apnea in primary care
International Journal of Community Medicine and Public Health, 2022
The most prevalent sleep-related breathing condition, obstructive sleep apnea (OSA), is linked to greater morbidity and poor cardiovascular outcomes. Even though sleep disorders are frequently present, primary care physicians hardly see or treat them. Better OSA symptom and intensity identification and classification to support OSA evaluation and diagnosis were the first outcomes of a task group of the American Academy of Sleep Medicine that produced quality metrics for the treatment of adult patients with the condition in 2015. The OSA screening tools (Berlin questionnaire, Epworth sleepiness scale, STOP Bang) have proven to be effective instruments for screening of sleep disorders. The present primary care practice approach for OSA screening and evaluation is disorganized and inadequate. Patients with OSA symptomatology are seen by primary care physicians, but they are not regularly screened, assessed, or referred to a sleep specialist. For the OSA screening assessments in general practice, more psychometric investigations are required. The findings from these investigations can be applied in real-world settings to improve OSA identification.
Journal of the American Board of Family Medicine, 2011
Background: Obstructive sleep apnea (OSA) is a reasonably common disorder that is associated with daytime tiredness and a host of medical conditions. Little is known about how primary care clinicians (PCCs) detect, diagnose, and manage patients who have OSA. Methods: We gathered information from 44 randomly selected practices in 5 regional practice-based research networks. This included interviews with PCCs and sleep consultants, medical records abstraction, and patient surveys. Descriptive analyses of the quantitative data were used to describe the prevalence of sleep symptoms, the proportion of primary care patients at high risk for OSA, and the methods used by PCCs to detect and diagnose patients with OSA. Results: More than 90% of adult patients visiting a PCC on any given day are experiencing sleep-related symptoms. Based on their Berlin Questionnaire scores, more than one third are at high risk of having sleep apnea. However, most patients have not discussed their sleep-related symptoms with their PCC, and fewer than one third have sleep-related symptoms documented in their medical records. Very few PCCs routinely screen for OSA, and, despite using billing records, problem lists, clinician and staff recall, and prospective logs enhanced by waiting room posters, PCCs were generally unable to identify 25 patients with OSA in their practices. Conclusions: A substantial proportion of patients who see PCCs regularly are at high risk for OSA. Very few of them are being diagnosed or treated. Clearer guidelines and a systematic approach are needed if this is indeed a problem that should be addressed.
Screening for High Risk of Sleep Apnea in an Ambulatory Care Setting in Saudi Arabia
International Journal of Environmental Research and Public Health
Sleep apnea is a potentially serious but under-diagnosed sleep disorder. Saudi Arabia has a high prevalence of hypertension, diabetes, obesity, and smoking, which are all major risk factors for sleep apnea. However, few studies report screening for sleep apnea in Saudi Arabia. A three-month prospective, questionnaire-based study, using the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), screened 319 patients attending a family medicine clinic in Saudi Arabia for risk of sleep apnea. The results showed that when using the BQ and the ESS, 95 (29.8%) and 102 (32.0%) respondents were at high risk of sleep apnea. Taken together, the BQ and the ESS combined measure showed that 41 (12.9%) respondents were classified as high risk for sleep apnea. Logistic regression revealed that the high risk of sleep apnea was statistically significantly (p < 0.05) associated with respondent characteristics of obesity and hypertension. No associations were found between high risk for ...
Sleep Medicine Research
Background and ObjectiveaaWith sleep disorders highly prevalent and associated with poor health outcomes, screening for sleep disorders in primary care could reduce the burden of chronic diseases and costs of health care. Currently, a brief comprehensive primarycare-friendly multiple-sleep-disorders screening instrument is not available. The Sleep Disorders Symptom Checklist (SDS-CL)-17, a singlepage instrument, was developed to screen for six sleep disorders (insomnia, obstructive sleep apnea, restless legs syndrome/periodic limb movement disorder, circadian rhythm sleep-wake disorders, narcolepsy, and parasomnias) and evaluated psychometrically. SDS-CL-17 psychometrics are reported. The resulting development of a more comprehensive single-page 25-item instrument, the SDS-CL-25, based on validation study results is described. Approaches for clinical use of the SDS-CL-25 are recommended. MethodsaaA cross-sectional study using nested data from two previous research studies (n = 395 sleep clinic referrals and n = 299 community volunteers) was used. SDS-CL-17 subscale scores and physician diagnoses were analysed using receiver operator characteristic curves. Resulting cut-point scores determined sensitivities/specificities. Study subject interview data were used to assess patient-friendliness of the instrument. ResultsaaSensitivities/specificities for the diagnosed sleep disorders ranged from 0.64 to 0.88. Interviewees endorsed the instrument as userfriendly. ConclusionsaaWhile the SDS-CL-17 is useful, the SDS-CL-25 assesses for a much larger number of sleep disorders yet retains brevity and is therefore recommended for ongoing clinical use. Psychometric evaluation of the SDS-CL-25 continues.