University of Nebraska Medical Center, USA.
University of Nebraska Medical Center, USA.
Sleep Med Rev. 2016 Oct;29:41-51. doi: 10.1016/j.smrv.2015.09.005. Epub 2015 Oct 22.
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and contributes to increased morbidity and compromised cardiovascular outcomes. Sleep disorders are common but rarely reported and addressed by primary health providers. An American Academy of Sleep Medicine task force (2015) released quality measures for the care of adult patients with OSA; the first outcome is improved detection and categorization of OSA symptoms and severity to promote assessment and diagnosis of the disorder. This state of the science integrative review aimed to evaluate the screening and assessment for OSA in primary care settings including the psychometric properties of OSA screening measures. Studies that met inclusion criteria were fourteen non-experimental and three experimental designs. OSA screening measurements (Berlin questionnaire, Epworth sleepiness scale, STOP Bang) with extensive validation studies were examined. Conclusions are that the current practice model of screening and assessment for OSA in primary care is fragmented and ineffective. Primary care providers encounter patients with OSA symptoms but do not routinely screen, assess, or refer to a sleep specialist. More psychometric research is needed for the OSA screening measurements in primary care. The results of these studies can be translated into practice to increase detection of OSA.
阻塞性睡眠呼吸暂停(OSA)是最常见的与睡眠相关的呼吸障碍,会导致发病率增加和心血管预后受损。睡眠障碍很常见,但初级保健提供者很少报告和处理。美国睡眠医学学会工作组(2015 年)发布了成人 OSA 患者护理质量措施;第一个结果是改善 OSA 症状和严重程度的检测和分类,以促进对该疾病的评估和诊断。本次循证整合评价旨在评估初级保健环境中 OSA 的筛查和评估,包括 OSA 筛查措施的心理测量学特性。符合纳入标准的研究包括 14 项非实验性研究和 3 项实验性设计。对经过广泛验证研究的 OSA 筛查测量(柏林问卷、嗜睡量表、STOP Bang)进行了检查。结论是,初级保健中 OSA 的筛查和评估现行实践模式是零散且无效的。初级保健提供者会遇到有 OSA 症状的患者,但不会常规进行筛查、评估或转介给睡眠专家。初级保健中 OSA 筛查测量需要更多的心理测量学研究。这些研究的结果可以转化为实践,以提高 OSA 的检出率。