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Bailes S, Rizzo D, Fichten C, Baltzan M, Grad R, Creti L, Amsel R, Libman E. Should testing for obstructive sleep apnea be offered routinely to older family medicine patients? A prospective cohort study. PSYCHOL HEALTH MED 2023; 28:1924-1937. [PMID: 36854649 DOI: 10.1080/13548506.2023.2176525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/22/2023] [Indexed: 03/02/2023]
Abstract
In our previous studies, we offered older family medicine patients testing for obstructive sleep apnea (OSA) and discovered that 80% of patients who accepted, were later diagnosed with unsuspected OSA. In the present study, we followed such patients for 3 years of usual treatment. The goals were to (1) observe whether wider testing for OSA would increase case recognition and treatment uptake; (2) identify symptom and health characteristics associated with diagnosis and treatment efficacy. 101 women and 75 men (>45 years) recruited from family medicine clinics completed questionnaires, polysomnography and consented to chart review (Time 1). Participants with OSA were offered treatment and follow-up with a sleep medicine specialist. All were re-evaluated after 3 years (Time 2). At Time 1, 93% of participants received a diagnosis of OSA. Of these, 53 initiated treatment (46 PAP therapy); at Time 2, 24 PAP users met criteria for adherence. PAP-adherent participants had worse OSA and worse reported symptoms at Time 1 than non-adherent participants. At Time 2, PAP-adherent participants improved on insomnia and daytime symptoms compared to non-adherent participants who showed no change. Adherent and non-adherent participants showed no difference in health indices at Time 1 and no change at three-year follow-up. Benefits of treatment included improvements in co-morbid insomnia and daytime functioning; however, offering wider testing for OSA to older, family medicine patients yielded a high rate of diagnosis but low treatment adoption and adherence. Therefore, a cost-effective strategy would identify and support those likely to adopt and adhere to treatment.
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Affiliation(s)
- Sally Bailes
- Jewish General Hospital, Psychiatry Department, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
- McGill University, Faculty of Medicine, Department of Psychiatry, Montreal, Canada
| | - Dorrie Rizzo
- McGill University, Faculty of Medicine, Department of Psychiatry, Montreal, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
| | - Catherine Fichten
- McGill University, Faculty of Medicine, Department of Psychiatry, Montreal, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
- Dawson College, Psychology Department, Montreal, Canada
| | - Marc Baltzan
- McGill University, Faculty of Medicine, Department of Epidemiology Biostatistics and Occupational Health, Montreal, Canada
- Mount Sinai Hospital, Sleep Apnea Clinic, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
- Institut de Médecine du Sommeil, Montreal, Canada
| | - Roland Grad
- Jewish General Hospital, Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
- Jewish General Hospital, Goldman Herzl Family Practice Center, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
- McGill University, Faculty of Medicine, Department of Family Medicine, Montreal, Canada
| | - Laura Creti
- Jewish General Hospital, Psychiatry Department, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
- McGill University, Faculty of Medicine, Department of Psychiatry, Montreal, Canada
| | - Rhonda Amsel
- McGill University, Department of Psychology, Montreal, Canada
| | - Eva Libman
- McGill University, Faculty of Medicine, Department of Psychiatry, Montreal, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux, Montreal, Canada
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Sawan N, Bakhsh H, Aldossary M, Alhussan R, Alharbi N, Abdellatif HM. Obstructive Sleep Apnea Awareness Among Dentists in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e36463. [PMID: 37090274 PMCID: PMC10115731 DOI: 10.7759/cureus.36463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVES This study aims to assess the knowledge and clinical practices among dentists in Saudi Arabia regarding obstructive sleep apnea (OSA). MATERIAL AND METHODS This cross-sectional study was conducted over a period of 8 months across the whole country. A self-administered questionnaire was used to assess the OSA knowledge and practices. The developed questionnaire was closed-ended questions and consisted of three parts: (1) demographic information such as age, gender, work experience, workplace, and specialty; (2) knowledge of OSA; and (3) OSA management practice. The knowledge score was calculated based on six questions, each of which gives one point when answered correctly. RESULTS A total of 450 dentists from all over the country were surveyed, with a predominance of females (55.6%) and Saudis (59%). About 56% learned about OSA in their undergraduate study, with theoretical lectures being the main source of information. The overall knowledge score was 3.09, with specialists having a higher score than general practitioners (GPs) (p<0.001) and those who learned about OSA in their post-graduate study having higher scores (p<0.001). Despite this, 58.89% never asked their patients about sleep history, and only 19.11% diagnosed patients with OSA before. Only 7.56% used oral appliances to treat OSA, and only one-quarter referred patients to a physician for a sleep-disordered diagnosis. However, 79.33% were willing to attend a continuing education course on managing OSA patients. CONCLUSION Our study shows that dentists in Saudi Arabia lack fundamental understanding regarding OSA and their role in screening, diagnosing, and treating patients with OSA, highlighting the need to educate the dental fraternity. Dental GPs and specialists, including orthodontists, must be actively involved in diagnosing and treating this life-threatening health issue.
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Affiliation(s)
- Nozha Sawan
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Heba Bakhsh
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Mohammed Aldossary
- General Directorate of Research and Studies, Ministry of Health, Riyadh, SAU
| | - Reema Alhussan
- Dentistry, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Nourah Alharbi
- Dentistry, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Hoda M Abdellatif
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
- Public Health Sciences, College of Dentistry, Texas A&M University, Dallas, USA
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P. Den Teuling NG, van den Heuvel ER, Aloia MS, Pauws SC. A latent-class heteroskedastic hurdle trajectory model: patterns of adherence in obstructive sleep apnea patients on CPAP therapy. BMC Med Res Methodol 2021; 21:269. [PMID: 34852769 PMCID: PMC8638441 DOI: 10.1186/s12874-021-01407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sleep apnea patients on CPAP therapy exhibit differences in how they adhere to the therapy. Previous studies have demonstrated the benefit of describing adherence in terms of discernible longitudinal patterns. However, these analyses have been done on a limited number of patients, and did not properly represent the temporal characteristics and heterogeneity of adherence. METHODS We illustrate the potential of identifying patterns of adherence with a latent-class heteroskedastic hurdle trajectory approach using generalized additive modeling. The model represents the adherence trajectories on three aspects over time: the daily hurdle of using the therapy, the daily time spent on therapy, and the day-to-day variability. The combination of these three characteristics has not been studied before. RESULTS Applying the proposed model to a dataset of 10,000 patients in their first three months of therapy resulted in nine adherence groups, among which 49% of patients exhibited a change in adherence over time. The identified group trajectories revealed a non-linear association between the change in the daily hurdle of using the therapy, and the average time on therapy. The largest difference between groups was observed in the patient motivation score. The adherence patterns were also associated with different levels of high residual AHI, and day-to-day variability in leakage. CONCLUSION The inclusion of the hurdle model and the heteroskedastic model into the mixture model enabled the discovery of additional adherence patterns, and a more descriptive representation of patient behavior over time. Therapy adherence was mostly affected by a lack of attempts over time, suggesting that encouraging these patients to attempt therapy on a daily basis, irrespective of the number of hours used, could drive adherence. We believe the methodology is applicable to other domains of therapy or medication adherence.
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Affiliation(s)
- Niek G. P. Den Teuling
- Dep. of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
| | - Edwin R. van den Heuvel
- Dep. of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mark S. Aloia
- Department of Medicine, National Jewish Health, Denver, CO USA
- Philips Respironics, Monroeville, PA USA
| | - Steffen C. Pauws
- Philips Research, Eindhoven, The Netherlands
- Department Communication and Cognition, Tilburg University, Tilburg, The Netherlands
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D'Rozario AL, Galgut Y, Crawford MR, Bartlett DJ. Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults. Sleep Med Clin 2021; 16:101-124. [PMID: 33485523 DOI: 10.1016/j.jsmc.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Continuous positive airway pressure (PAP) is still the most efficacious treatment for obstructive sleep apnea when used effectively. Since the availability of PAP 39 years ago there have been considerable technological advances, such as quieter, lighter and smaller machines with better humidification. However, adherence to treatment is still a major problem. This article reviews studies published on behavioral interventions aimed at improving the uptake and maintenance of PAP treatment (January 2016-February 2020). It discusses underlying factors in the poor uptake and discontinuation of treatment and the role of qualitative research to better understand the perspective of the patients.
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Affiliation(s)
- Angela L D'Rozario
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Level 2, Building D17, Johns Hopkins Drive, Camperdown, New South Wales 2050, Australia; Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney.
| | - Yael Galgut
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
| | - Megan R Crawford
- The University of Strathclyde, Graham Hills Building, 50 George Street, Glasgow G1 1QE, UK
| | - Delwyn J Bartlett
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney
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Abstract
The concept of sleep health provides a positive holistic framing of multiple sleep characteristics, including sleep duration, continuity, timing, alertness, and satisfaction. Sleep health promotion is an underrecognized public health opportunity with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease. Using a socioecological framework, we describe interacting domains of individual, social, and contextual influences on sleep health. To the extent that these determinants of sleep health are modifiable, sleep and public health researchers may benefit from taking a multilevel approach for addressing disparities in sleep health. For example, in addition to providing individual-level sleep behavioral recommendations, health promotion interventions need to occur at multiple contextual levels (e.g., family, schools, workplaces, media, and policy). Because sleep health, a key indicator of overall health, is unevenly distributed across the population, we consider improving sleep health a necessary step toward achieving health equity.
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Affiliation(s)
- Lauren Hale
- Program in Public Health; and Department of Family, Population, and Preventive Medicine; Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794-8338, USA;
| | - Wendy Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania 15213, USA;
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA;
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