Assessing Excessive Sleepiness in Primary Care
- Credit Type
- CME
- Credit Amount
- 0.25
- Release Date
- 01/05/2010
- Expiration Date
- 01/04/2011
- Activity Type
- Videocast
Assessing Excessive Sleepiness in Primary Care
Excessive sleepiness (ES) is a common problem that results in significant morbidity and mortality, including high rates of motor vehicle and work-related accidents, cardiovascular disease, and emotional lability.1 ES may also be a sign of a serious underlying condition, such as sleep-disordered breathing, circadian rhythm sleep disorders (CRSD), or a psychiatric disorder, each with its own pathologic sequelae. Studies suggest that hypoxia and sleep fragmentation in patients with obstructive sleep apnea (OSA), for example, are associated with ES and may cause irreversible damage to brain regions that govern cognitive and behavioral functioning, as well as areas that mediate sleep and wakefulness. 2 CRSDs such as shift work sleep disorder, jet lag disorder, and delayed and advanced sleep phase syndrome are also often associated with ES. The chronic misalignment of the internal biological clock observed in patients with CRSDs impairs cognitive and physical performance, and may be carcinogenic, although the precise pathologic mechanisms have not been fully elucidated. 3 Clearly, the causes and consequences of ES demand multidimensional assessment and differential diagnosis to guide therapeutic decision making. Yet despite significant adverse effects on patient safety, productivity, and well-being, sleep/wake disorders are underdiagnosed and undertreated, in part because of inadequate patient assessment by primary care physicians (PCPs). The 2005 Sleep in America Poll found that 70% of respondents were never asked about sleep by their physicians. 4 As a result, PCPs commonly overlook hallmark symptoms of sleep/wake disorders, including ES. Integrating questions about sleep patterns when obtaining a general medical history can help identify potential sleep/wake disturbances. 5-7 For example, patients and, whenever possible, bed partners should be asked about snoring as an indication of OSA. Inquiries into sleep habits may also reveal that patients are excessively sleepy during waking hours, yet have trouble falling asleep at their desired bedtime (sleep-onset insomnia), symptomatology suggestive of a CRSD. 6 Assessing patients for symptoms of disturbed sleep, including ES, will facilitate timely diagnoses of sleep/wake disorders and appropriate multimodal management.
- Schwartz JR, Roth T. Shift work sleep disorder: burden of illness and approaches to management. Drugs. 2006;66(18):2357-2370.
- Beebe DW, Gozal D. Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res. 2002;11(1):1-16.
- Erren TC, Morfeld P, Stork J, et al. Shift work, chronodisruption and cancer?--The IARC 2007 challenge for research and prevention and 10 theses from the Cologne Colloquium 2008. Scand J Work Environ Health. 2009;35(1):74-79.
- 2005 Sleep in America Poll: Summary of Findings. Washington, DC: National Sleep Foundation; 2005.
- Schwartz JR, Roth T, Hirshkowitz M, Wright KP. Recognition and management of excessive sleepiness in the primary care setting. Prim Care Companion J Clin Psychiatry. 2009;11(5):197-204.
- Doghramji K. Assessment of excessive sleepiness and insomnia as they relate to circadian rhythm sleep disorders. J Clin Psychiatry. 2004;65 suppl 16:17-22.
- Baran AS, Chervin RD. Approach to the patient with sleep complaints. Semin Neurol. 2009;29(4):297-304.
Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications
This activity is supported by an educational grant from Cephalon, Inc.
Date of Release: 1/5/2010
Date of Expiration: 1/4/2011
Activity Goal
Employing a combination of didactic and practical case-based presentations, the goal of this activity is to highlight scientific and clinical data emphasizing the relationship between sleep, memory, and emotion.
Intended Audience
This activity is intended for sleep specialists, primary case physicians, and other health care providers interested in sleep/wake medicine.
There are no prerequisites for this educational activity.
Statement of Need
Developed for community-based sleep clinicians and primary care physicians, and designed to provide a scientific rationale for individualized assessment and treatment of patients with sleep/wake disorders, this program presents the neurobiologic relationship between sleep, memory, and emotion.
Learner’s Gap
Sleep/wake disorders significantly reduce the restorative value of sleep. Characterized by their heterogeneity and profound effects on patient function, the disorders are often prevalent, underrecognized, and undertreated. Inadequate treatment is associated with significant morbidity and mortality, an association gaining increased attention among clinical researchers. Healthcare-associated costs are prohibitively burdensome, estimated at nearly USD 100 billion per annum. Data from numerous epidemiologic and randomized controlled studies clearly demonstrate that patients with disrupted sleep/wake patterns have significantly impaired daytime function and experience excessive sleepiness, a debilitating symptom with far-reaching consequences. Sleep clinicians need to improve their understanding of the morbidity associated with sleep/wake disorders, to communicate the issues to their colleagues and to their patients, and to tailor therapies accordingly.
Learning Objectives
At the completion of this initiative, the participants should be better prepared to:
- Discuss the morbidity associated with sleep/wake disorders across neurocognitive, neurophysiologic, and executive domains
- Explain the neurophysiologic basis of the potentially irreversible neurocognitive, memory, and executive deficits in patients with obstructive sleep apnea and other sleep/wake disorders
- Evaluate potential neuropsychologic and executive deficits in patients with sleep/wake disorders
- Monitor progress during treatment of patients with sleep/wake disorders, emphasizing neurocognitive and neurobehavioral function
- Utilize nonpharmacologic and pharmacologic treatment modalities to improve sleep/wake consolidation and patient function
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
Albert Einstein College of Medicine designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Credit Designation Conflict of Interest Statement
The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present. Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States. Faculty participating in this activity have indicated the following disclosure information:
Richard D. Simon Jr, MD
Ventus Medical (grant/research support); The McMahon Group (honorarium)
The staff at Albert Einstein College of Medicine has no disclosures to report other than the following:
Steven Jay Feld, or a member of his household, owns securities in Bioheart, Inc.; Chelsea Therapeutics, Inc.; and Pharmacopeia, Inc.
Chris Ontiveros, PhD, (senior scientific associate, Asante Communications) has no conflicts of interest with commercial interests related directly or indirectly to this educational activity.
Method of Participation
There are no fees for participating in and receiving credit for this activity. The participant must read the objectives and enduring material, and answer the multiple-choice post-test. Please complete the evaluation form which provides each participant with the opportunity to comment on the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his/her views on future educational needs. A score of at least 70% is required to obtain CME credit for this activity. Credit is available through January 4, 2011.
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Copyright Information
Copyright © 2010 Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission, except in the case of brief quotations embodied in articles or reviews.
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