Management of Sleep/Wake Disorders in Primary Care
- Credit Type
- CME
- Credit Amount
- 0.25
- Release Date
- 01/25/2010
- Expiration Date
- 01/24/2011
- Activity Type
- Videocast
Sleep/wake disorders are often characterized by unconsolidated, nonrestorative sleep, which can cause excessive sleepiness, neurocognitive impairment, and increased work-related and motor vehicle accidents.[1-3] Despite their prevalence and negative consequences, sleep/wake disorders are underdiagnosed and undertreated.[4-6] Primary care physicians are uniquely positioned to recognize, diagnose and manage these chronic conditions as well as the myriad of commonly associated morbidities, including hypertension, metabolic disorders, and gastrointestinal disturbances. Initial patient assessment should begin with a thorough medical history and physical examination.[7] Inquiries into the patient’s quality and quantity of sleep can be complemented with self-report sleepiness questionnaires, such as the Epworth Sleepiness Scale and sleep diaries/logs.[8] More specific questions regarding sleep onset difficulties, snoring, and involuntary movements and waking during sleep, for example, can facilitate a differential diagnosis of excessive sleepiness and/or disturbed sleep. Bed partner interviews can provide additional information, particularly if patients are not aware of their sleep habits. At times, referral to a sleep specialist may be necessary when sleep complaints persist despite treatment or to confirm a presumptive diagnosis of obstructive sleep apnea or narcolepsy with an overnight sleep study. Regardless of the cause of the patient’s sleepiness, approaches to improve sleep quality and quantity should be considered. Behavioral treatment may include good sleep hygiene, scheduled naps, and avoidance of light close to or during sleep time. Pharmacologic approaches to promote wakefulness may also be helpful to some patients. While ongoing management and periodic follow-up with patients can usually be performed in the primary care setting, some patients may require continued collaboration with a sleep specialist, including explicitly defined roles for each health care provider.
References
- Stone, K.C., et al., Nonrestorative sleep. Sleep Med Rev, 2008. 12(4): p. 275-88.
- Al Lawati, N.M., S.R. Patel, and N.T. Ayas, Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis, 2009. 51(4): p. 285-93.
- Malik, S.W. and J. Kaplan, Sleep deprivation. Prim Care, 2005. 32(2): p. 475-90.
- Kapur, V., et al., Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath, 2002. 6(2): p. 49-54.
- American Academy of Sleep Medicine, et al., International Classification of Sleep Disorders Revised. 2005, American Academy of Sleep Medicine: Westchester, IL.
- National Sleep Foundation's 2009 Sleep in America Poll: Highlights and Key Findings. Available from: http://healthyliving.freedomblogging.com/files/2009/03/2009sleeppoll.pdf. Accessed February 1, 2010.
- Schwartz, J.R., et al., Recognition and management of excessive sleepiness in the primary care setting. Prim Care Companion J Clin Psychiatry, 2009. 11(5): p. 197-204.
- Devine, E.B., Z. Hakim, and J. Green, A systematic review of patient-reported outcome instruments measuring sleep dysfunction in adults. Pharmacoeconomics, 2005. 23(9): p. 889-912.
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.
Activity Goal
Employing a digital format, this activity aims to disseminate best practices in the individualized assessment, diagnosis, and management of patients with sleep/wake disorders.
Intended Audience
This activity is intended for sleep clinicians, primary care physicians, physician assistants, nurse practitioners, and other healthcare providers interested in improving their knowledge base and skill sets in sleep/wake medicine. There are no prerequisites for this educational activity.
Statement of Need
Sleep/wake disorders significantly reduce the restorative value of sleep. Characterized by their heterogeneity and profound effects on patient function, these disorders are prevalent and often inadequately treated, resulting in significant morbidity and mortality. Healthcare-related costs are particularly 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 function and experience excessive sleepiness, a debilitating symptom with far reaching consequences. Furthermore, comorbidities associated with sleep/wake disorders may not be completely reversible, highlighting the importance of early diagnosis and ongoing management. Healthcare providers need to improve their understanding of the morbidity associated with sleep/wake disorders, communicate the issues to their colleagues and patients, and tailor therapies accordingly.
Learner’s Gap
Sleep/wake disorders are underdiagnosed, underrecognized, and undertreated. Evidence based discussions supported by expert clinical experience provide a scientific and clinical rationale for individualized assessment and treatment of patients with sleep/wake disorders. Emphasizing he biopsychosocial and potentially irreversible
consequences of untreated disturbances in sleep/wake consolidation enables clinicians to better assess and manage sleep/wake
Learning Objectives
At the completion of this initiative, participants should be better prepared to:
- Discuss the morbidity associated with obstructive sleep apnea, shift-work sleep disorder, and other common sleep/wake disorders across biological, psychological, and social domains
- Recognize, evaluate, and diagnose patients presenting with excessive sleepiness and signs and symptoms associated with obstructive sleep apnea, shift-work sleep disorder, and other common sleep/wake disorders
- Stratify patients by risk and severity of obstructive sleep apnea and other common sleep/wake disorders and recognize patients who require referral
- Employ nonpharmacologic and/or pharmacologic treatment modalities to ameliorate underlying causes, signs, and symptoms of common sleep/wake disorders
- Monitor treatment compliance and therapeutic progress of patients with obstructive sleep apnea and other common sleep/wake disorders
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 K. Bogan, MD
Addrenex (Consultant); Cephalon (Consultant, Speakers Bureau, Grant/Research); GlaxoSmithKline (Consultant); Jazz Pharmaceuticals (Consultant, Speakers Bureau); Johnson & Johnson (Grant/Research); Merck (Grant/Research); Pfizer (Grant/Research); sanofi-aventis (Speakers Bureau); Sepracor (Speakers Bureau), SleepMed Inc.(Stockholder)
Michael J. Thorpy, MD Cephalon; Jazz Pharmaceuticals (Consultant, Speakers Bureau)
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 fill-out the attestation statement. 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. Credit is available through January 24, 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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