Espinel Paola, Cho Garry, Marshall Nathaniel S, Yee Brendon J, Smith Kathleen, D'Rozario Angela L, Ainge-Allen Henry W, Stranks Lachlan, Gauthier Gislaine, Lambert Timothy, Grunstein Ronald R
Sleep and Circadian Research Group, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia.
School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
BMJ Open. 2025 Apr 30;15(4):e092034. doi: 10.1136/bmjopen-2024-092034.
Medical care for sleep-disordered breathing (SDB) in severe mental illness (SMI) is often ignored or poorly delivered. Here we describe an oximetry screening and management pathway for obstructive sleep apnoea (OSA) and assess the night-to-night reliability in a specialist cardiometabolic disease management clinic for patients with SMI.
The implementation and evaluation of a sleep service for patients living with SMI.
Prospective evaluation of a translational programme.
A multidisciplinary outpatient clinic for patients with SMI.
The clinic was prospectively evaluated between May 2019 and December 2020. We used questionnaires and three nights of oximetry to screen patients for OSA. A project coordinator managed the testing-treatment pathway while liaising with health care providers. We also evaluated the agreement between two nights of oximetry.
It is feasible to integrate sleep service into a cardiometabolic clinic for patients with SMI. Oximetry data were collected from 140/153 patients and 129/140 had at least adequate oximetry data for one night, and 107 (82%) had two nights. Oximetry indicated likely moderate-to-severe OSA in 33 patients and severe OSA in 22 patients. A total of 96/140 patients were referred to the SMI sleep clinic, and 40 (42%) recommended polysomnography (PSG) and 31 (78%) completed PSG. Of the 44 patients recommended continuous positive airway pressure (CPAP) therapy, 38 initiated CPAP and 20 (51.3%) demonstrated adherence (>4 hours 70% of nights over 30 days). Bland-Altman analysis of two nights of oxygen desaturation events greater than 4% per hour found a mean difference of -0.2 (95% CI -14.0 to 14.0). Misclassification of OSA severity was seen in 12 patients (18.7%).
Our recount shows the feasibility and effectiveness of implementing a sleep service in a cardiometabolic clinic for patients with SMI, and using oximetry is an effective diagnostic test of SDB. Having a dedicated project coordinator to oversee the clinical pathway avoids fragmentation of clinical services.
严重精神疾病（SMI）患者的睡眠呼吸障碍（SDB）医疗护理常常被忽视或提供不足。在此，我们描述一种用于阻塞性睡眠呼吸暂停（OSA）的血氧饱和度监测筛查和管理路径，并评估在一家专门的心脏代谢疾病管理诊所中，针对SMI患者夜间监测结果的可靠性。
为SMI患者实施并评估一项睡眠服务。
对一项转化项目进行前瞻性评估。
一家为SMI患者设立的多学科门诊诊所。
于2019年5月至2020年12月对该诊所进行前瞻性评估。我们使用问卷和三晚的血氧饱和度监测来筛查患者是否患有OSA。一名项目协调员管理检测 - 治疗路径，同时与医疗服务提供者联络。我们还评估了两晚血氧饱和度监测结果之间的一致性。
将睡眠服务整合到为SMI患者设立的心脏代谢诊所是可行的。从153名患者中的140名收集到了血氧饱和度监测数据，其中129名（140名中的）至少有一晚的血氧饱和度监测数据足够，107名（82%）有两晚的数据。血氧饱和度监测显示33名患者可能患有中度至重度OSA，22名患者患有重度OSA。共有96/140名患者被转诊至SMI睡眠诊所，40名（42%）被建议进行多导睡眠图（PSG）检查，31名（78%）完成了PSG检查。在44名被建议进行持续气道正压通气（CPAP）治疗的患者中，38名开始使用CPAP，20名（51.3%）表现出依从性（在30天内70%的夜晚使用时间超过4小时）。对两晚每小时血氧饱和度下降超过4%的事件进行布兰德 - 奥特曼分析发现，平均差异为 -0.2（95%可信区间为 -14.0至14.0）。12名患者（18.7%）出现了OSA严重程度的错误分类。
我们的叙述表明，在为SMI患者设立的心脏代谢诊所中实施睡眠服务是可行且有效的，并且使用血氧饱和度监测是SDB的一种有效诊断测试。有一名专门的项目协调员来监督临床路径可避免临床服务的碎片化。
