Intimate partner violence: a guide for primary care providers

In-office communication about excessive daytime sleepiness associated with treated obstructive sleep apnea: insights from an ethnographic study of physician-patient visits

Background

Excessive daytime sleepiness (EDS), a primary symptom of obstructive sleep apnea (OSA), negatively affects functioning and quality of life (QoL). EDS can persist despite primary airway therapy, and often remains unmanaged, potentially due to inadequate provider-patient communication. Ethnographic research was conducted to assess provider-patient communication about EDS.

Methods

Participating physicians (primary care n = 5; pulmonologists n = 5; sleep specialists n = 3) identified adult patients (n = 33) diagnosed with OSA who were prescribed positive airway pressure (PAP) therapy ≥6 months prior and previously reported EDS. Visits and post-visit interviews were video-recorded and analyzed using standardized, validated sociolinguistic techniques.

Results

Despite 55% of patients (18/33) reporting QoL impacts post-visit, this was discussed during 28% (5/18) of visits. Epworth Sleepiness Scale was administered during 27% (9/33) of visits. Many patients (58% [19/33]) attributed EDS to factors other than OSA. Physicians provided EDS education during 24% of visits (8/33). Prior to the visit, 30% (10/33) of patients were prescribed EDS medication, of which 70% (7/10) reported currently experiencing EDS symptoms.

Conclusions

EDS was minimally discussed and rarely reassessed or treated after PAP therapy initiation in this study. Patients often attributed EDS to factors other than OSA. The findings suggest physicians and patients may benefit from dialogue tools, routine use of screening tools, and patient education.

The Relationship Between Parents' Intimate Partner Victimization and Youths' Adolescent Relationship Abuse

Witnessing inter-parental intimate partner violence has been found to be associated with adolescents' own relationship abuse. This study investigates the relationship between patterns of inter-parental intimate partner verbal and physical violence victimization reported by parents and their children's reports of dating abuse experiences and behavior. Latent class analysis was performed on a sample of 610 parents (42% male and 67% white) and their dating adolescent children (ages 12-21 years; 52% male). Parents reported five types of victimization by their partners in the past year, while youth concurrently reported their own victimization and perpetration within their dating relationships. Three profiles of parents' intimate partner victimization were related to youth relationship abuse experiences and behaviors. Children of parents who experienced verbal abuse were more likely to experience similar patterns in their own relationships, whereas children of parents who report physical and verbal abuse were more likely to report psychological, physical and sexual abusive encounters in their partnerships. Findings indicate that parents' relationship quality and abusive behaviors may have a long lasting effect on their children as they enter mid and late adolescence. Parents should pay attention to their own relationship quality and behavior even as their teen-age children gain independence.