Department of Family Medicine, McGill University, Montréal, Québec, Canada.
Centre Intégré Universitaire des Soins et Services Sociaux de l'ouest de l'île, Lady Davis Institute for Medical Research, Montréal, Québec, Canada.
J Clin Sleep Med. 2021 Mar 1;17(3):429-434. doi: 10.5664/jcsm.8922.
In the context of the current COVID-19 pandemic situation, we address the following important questions: (1) How can patients be identified for possible OSA while sleep clinic testing is temporarily unavailable or limited? and (2) What measures can be suggested to improve sleep health until proper diagnosis and treatment become safe and available again?
As a proxy for home or in-laboratory testing, validation of a symptom-based measure of OSA risk is presented, based on an ongoing larger prospective study of 156 family medicine patients with OSA (88 women, 68 men; mean age, 57 years) and 60 control participants (36 women, 24 men; mean age, 54 years) recruited from the community. Participants completed the Sleep Symptom Checklist (SSC) and a range of other self-report measures; primary care patients also underwent a polysomnographic sleep study.
Results showed that (1) individuals with OSA reported more symptoms on the SSC related to insomnia, daytime symptoms, sleep disorders, and psychological maladjustment than did the control group (all P < .001), and (2) their sleep-related symptoms were significantly more severe than those of the control patients. In addition, several polysomnographic indices in recently diagnosed untreated individuals with OSA were significantly correlated with SSC measured sleep disorder symptoms, and SSC scores significantly distinguished participants with OSA from control participants.
Our findings suggest that family practitioners can effectively prescreen patients for possible OSA by inquiring about 5 items that form the SSC sleep disorders subscale. If OSA is suspected, then we can recommend a range of behavioral techniques to improve symptoms. The current pandemic causes us to reflect that the provisional targeting of symptoms and guidance regarding mitigation strategies while waiting for specialist care could serve patients well at any time.
在当前 COVID-19 大流行的背景下，我们要解决以下两个重要问题：（1）在睡眠诊所检测暂时不可用或有限的情况下，如何识别可能患有阻塞性睡眠呼吸暂停（OSA）的患者？（2）在适当的诊断和治疗再次变得安全可行之前，可以提出哪些措施来改善睡眠健康？
作为家庭或实验室检测的替代方法，提出了一种基于正在进行的 156 名患有 OSA 的家庭医学患者（88 名女性，68 名男性；平均年龄 57 岁）和 60 名对照参与者（36 名女性，24 名男性；平均年龄 54 岁）的更大前瞻性研究的基于症状的 OSA 风险评估方法的验证，这些参与者是从社区招募的。参与者完成了睡眠症状检查表（SSC）和一系列其他自我报告措施；初级保健患者还接受了多导睡眠图睡眠研究。
结果表明：（1）与对照组相比，患有 OSA 的个体在 SSC 上报告了更多与失眠、白天症状、睡眠障碍和心理失调相关的症状（均 P <.001），（2）他们的睡眠相关症状明显比对照组患者更严重。此外，最近诊断为未经治疗的 OSA 个体的几项多导睡眠图指数与 SSC 测量的睡眠障碍症状显著相关，SSC 评分显著区分了 OSA 患者和对照组患者。
我们的发现表明，家庭医生可以通过询问 SSC 睡眠障碍子量表的 5 个项目，有效地对可能患有 OSA 的患者进行初步筛查。如果怀疑患有 OSA，则可以建议采用一系列行为技术来改善症状。当前的大流行促使我们反思，在等待专家治疗时，针对症状进行临时靶向治疗和提供缓解策略的指导，可以在任何时候都为患者带来好处。
