ABSTRACT
BACKGROUND AND PURPOSE: To determine the recognition of sleep disorders in a community-based outpatient health setting following an educational intervention for health care professionals. Previously we have reported very low rates of recognition of sleep disorders in minority and medically indigent populations in a community-based setting. This omission is significant, since there is evidence of an increased number of sleep disorders among minority populations. PATIENTS AND METHODS: In-service training on sleep and sleep disorders was conducted over a 4-year period. Patients screened at the health center with suspected sleep disorders were referred to a hospital-based sleep laboratory. Rates of recognition and referral for sleep-related disorders were compared over the 4-year period using the sleep lab and health center databases and patient chart review at the health center. RESULTS: The intervention program was highly rated and well attended by staff. Rates of referral for sleep testing significantly increased from pre-intervention (0.06%) to the last year post-intervention (0.21%). Overall prevalence rate for sleep diagnoses increased similarly (0.11 vs. 0.26%). CONCLUSIONS: The educational intervention was effective in increasing rates of recognition and diagnosis, although the rate remains low compared to the estimated prevalence of sleep disorders in the general population. Despite broad coverage of sleep disorders during the training program, OSA was the primary diagnosis. Further examination of factors leading to the lack of recognition of other primary sleep disorders needs to be addressed in this patient group.
Subject(s)
Ambulatory Care Facilities , Health Personnel/education , Inservice Training/standards , Sleep Wake Disorders/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Prevalence , Referral and Consultation , Sleep Wake Disorders/epidemiologyABSTRACT
BACKGROUND: Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients' morbidity. Clustering nocturnal care has been recommended to improve patients' sleep. OBJECTIVES: To (1) examine the frequency, pattern, and types of nocturnal care interactions with patients in 4 critical care units; (2) analyze the relationships among these interactions and patients' variables (age, sex, acuity) and site of admission to the intensive care unit; and (3) analyze the differences in patterns of nocturnal care activities among the 4 units. METHODS: A randomized retrospective review of the medical records of 50 patients was used to record care activities from 7 PM to 7 AM in 4 critical care units. RESULTS: Data consisted of interactions during 147 nights. The mean number of care interactions per night was 42.6 (SD 11.3). Interactions were most frequent at midnight and least frequent at 3 AM. Only 9 uninterrupted periods of 2 to 3 hours were available for sleep (6% of 147 nights studied). Frequency of interactions correlated significantly with patients' acuity scores (r = 0.32, all Ps < .05). A sleep-promoting intervention was documented for only 1 of the 147 nights, and 62% of routine daily baths were provided between 9 PM and 6 AM. CONCLUSIONS: The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.
