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Gentin N, Howarth TP, Crossland G, Patel H, Jonas C, Blecher G, Widger J, Whybourne A, Heraganahally SS. Establishing a telehealth model addressing paediatric sleep health in remote and rural Northern Territory Australia: Overcoming the distance barrier. J Paediatr Child Health 2024; 60:212-221. [PMID: 38726707 DOI: 10.1111/jpc.16549] [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: 06/15/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 07/07/2024]
Abstract
AIM This study examined the outcomes of a telehealth model for sleep health assessment among Indigenous and non-Indigenous children residing in remote and regional communities at the Top End Northern Territory (NT) of Australia. METHODS Video telehealth consultation, that included clinical history and relevant physical findings assessed virtually with an interstate paediatric sleep physician was conducted remotely. Polysomnography (PSG) and therapeutic interventions were carried out locally at Darwin, NT. The study participants were children referred between 2015 and 2020. RESULTS Of the total 812 children referred for sleep assessment, 699 underwent a diagnostic PSG. The majority of patients were female (63%), non-Indigenous (81%) and resided in outer regional areas (88%). Indigenous children were significantly older and resided in remote or very remote locations (22% vs. 10%). Referral patterns differed according to locality and Indigenous status - (non-Indigenous via private (53%), Indigenous via public system (35%)). Receipt of referrals to initial consultation was a median of 16 days and 4 weeks from consult to PSG. Remote children had slightly longer time delay between the referral and initial consult (32 vs. 15 days). Fifty one percent were diagnosed to have OSA, 27% underwent adenotonsillectomy and 2% were prescribed with CPAP therapy. CONCLUSIONS This study has demonstrated that a telehealth model can be an effective way in overcoming logistical barriers and in providing sleep health services to children in remote and regional Australia. Further innovative efforts are needed to improve the service model and expand the reach for vulnerable children in very remote communities.
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Affiliation(s)
- Natalie Gentin
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Sydney Children's Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy P Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Applied Physics, University of Eastern Finland, Kuopio, Northern Savonia, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Northern Savonia, Finland
| | - Graeme Crossland
- Department of ENT, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Hemi Patel
- Department of ENT, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Catherine Jonas
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Paediatric Sleep Service, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
| | - Gregory Blecher
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Sydney Children's Hospital, Sydney, New South Wales, Australia
- Liverpool Paediatric Care, Liverpool, New South Wales, Australia
| | - John Widger
- Division of Paediatric Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Annie Whybourne
- Women Children and Youth Division, NT Health, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
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Fagundes NCF, Young R, Flores-Mir C, Heo G, Perez A. Parental experiences in navigating health services for paediatric residual obstructive sleep apnoea: An exploratory qualitative descriptive study. Orthod Craniofac Res 2024. [PMID: 38590218 DOI: 10.1111/ocr.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES To explore parents' experiences and perceptions regarding engagement in health services for managing residual paediatric obstructive sleep apnoea (OSA) across levels of care. METHODS Qualitative description guided study design. Data were collected through semi-structured interviews with parents of children diagnosed with residual OSA at a university-based sleep clinic. The relevant literature informed the interview guide and was piloted before data collection. Inductive, manifest content analysis was used to describe parents' perceptions and experiences using data-driven categories and sub-categories. Several strategies were employed to ensure rigour in this study. RESULTS Eight interviews were conducted. Parents' views were organized into five categories: awareness of the sleep issue, interaction with non-sleep specialists, interaction with sleep specialists, interaction with dental professionals, and further actions and support. Parents reported several engagement issues due to their interactions with different care providers. These issues included having to personally identify and raise the sleep problem, feeling that care providers did not take this problem seriously, waiting for an extended period to be referred for sleep services, and receiving conflicting or insufficient treatment recommendations. Overall, parents perceived that their actions and the services received across levels of care were not effective enough to address paediatric OSA. CONCLUSION Based on this exploratory qualitative descriptive research, along with developing evidence-based clinical guidelines for paediatric OSA screening and management tailored to different levels of care, strategies intended to improve the engagement of patients and care providers in addressing paediatric OSA should be developed and empirically tested.
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Affiliation(s)
- Nathalia Carolina Fernandes Fagundes
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthodontics, Faculty of Dentistry, Federal University of Para, Belém, Brazil
| | - Rochelle Young
- Division of Pulmonary and Sleep Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Giseon Heo
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Wang XQ, Wang Y, Yu K, Ma R, Zhang JY, Zhou YQ. Experiences of care-seeking by schizophrenia patients with delayed diagnosis and treatment in rural China: A qualitative study. Int J Soc Psychiatry 2023; 69:1453-1461. [PMID: 37036139 DOI: 10.1177/00207640231164010] [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] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patients with schizophrenia in rural areas of China face severe delays in getting appropriate treatment due to poverty, transportation, and limited availability of mental healthcare services. However, the experiences of care-seeking among patients with delayed diagnosis and treatment in rural areas remain poorly understood, and it remains unclear how these experiences influence patients' medical mistrust or expectations of care. This study aims to fill that void. METHODS We applied a qualitative phenomenological method. Patients were recruited through purposive sampling at a psychiatric hospital in Harbin, China. Semi-structured, one-to-one interviews were conducted, guided by an interview outline. Thematic analysis was performed using Colaizzi's seven-step method. RESULTS Data saturation was achieved after interviewing 13 participants aged 21 to 53 years. Three themes with eight subthemes were identified: (i) Barriers to seeking care, (ii) Feelings for psychiatric treatment, and (iii) Demand for mental healthcare. Several factors that may impede the timely diagnosis and treatment were identified, including patients, physicians, and institutions. The participants described their feelings of adverse treatment experiences, as well as expectations arising from this process. It predominantly covers awareness of the disease, supportive access to care, and geographic accessibility of services. CONCLUSION Patients with delayed diagnosis and treatment in rural areas often have negative experiences and various needs for mental health services in the pursuit of effective treatments. Policymakers and health planners should seriously consider the current challenges in rural mental healthcare to develop comprehensive strategies for improving prehospital delays and medical experience for this group of patients.
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Affiliation(s)
- Xiao-Qing Wang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Wang
- Department of Nursing, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Kai Yu
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rui Ma
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia-Yuan Zhang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
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Duan KI, Donovan LM. Coverage Decisions for Positive Airway Pressure Therapy: Intended and Unintended Consequences. Ann Am Thorac Soc 2023; 20:28-29. [PMID: 36584987 PMCID: PMC9819257 DOI: 10.1513/annalsats.202211-912ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Kevin I Duan
- University of Washington, Seattle, Washington and
- Health Services Research and Development, Veterans Affairs Puget Sound, Seattle, Washington
| | - Lucas M Donovan
- University of Washington, Seattle, Washington and
- Health Services Research and Development, Veterans Affairs Puget Sound, Seattle, Washington
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Newcomb P, Tadlock J, Nelson T, Urban R, Mullen H, Cordero R, Thinn S. Relationship between sleep apnea and hospital readmission in rural and urban populations. Public Health Nurs 2022; 39:1227-1234. [PMID: 35789117 DOI: 10.1111/phn.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate geographic differences in obstructive sleep apnea (OSA) prevalence, to determine if readmissions were more likely among rural patients with OSA than others, and to model predictors, including diagnosed OSA, of 30, 60, and 90-day acute-care readmissions. DESIGN This cohort study employed a secondary analysis of data extracted from the electronic health record shared by all hospitals in a north Texas healthcare system. SAMPLE The sample consisted of records associated with 472,503 adult patients admitted to any of the study system's acute-care facilities from 2016 through 2019. MEASUREMENTS Measurements consisted of case-level health information, including admissions, demographic variables, payors, diagnoses, screens, and physician orders. RESULTS OSA was significantly related to hospital readmission when considered in isolation but did not significantly predict readmission when modeled with plausible covariates. Screening rates for OSA did not vary by geography. Differences in rural/urban-suburban OSA prevalence were not statistically significant. CONCLUSIONS Findings contrast with previous suggestions that OSA plays an independent role in hospital readmissions or that rural resident may be disadvantaged regarding services that support the OSA diagnosis. Prevalence and screening rates were almost identical in urban and rural populations.
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Affiliation(s)
| | - Joell Tadlock
- Texas Health Stephenville Hospital, Stephenville, Texas, USA
| | | | - Regina Urban
- Texas Health Arlington Memorial Hospital, Arlington, Texas, USA
| | - Hannah Mullen
- Texas Health Cleburne Hospital, Cleburne, Texas, USA
| | - Rosette Cordero
- Texas Health Methodist Fort Worth Hospital, Fort Worth, Texas, USA
| | - Su Thinn
- Texas Health Methodist Fort Worth Hospital, Fort Worth, Texas, USA
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Abstract
Sleep Apnoea (SA) is a common chronic illness that affects nearly 1 billion people around the world, and the number of patients is rising. SA causes a wide range of psychological and physiological ailments that have detrimental effects on a patient’s wellbeing. The high prevalence and negative health effects make SA a public health problem. Whilst the current gold standard diagnostic procedure, polysomnography (PSG), is reliable, it is resource-expensive and can have a negative impact on sleep quality, as well as the environment. With this study, we focus on the environmental impact that arises from resource utilisation during SA detection, and we propose remote monitoring (RM) as a potential solution that can improve the resource efficiency and reduce travel. By reusing infrastructure technology, such as mobile communication, cloud computing, and artificial intelligence (AI), RM establishes SA detection and diagnosis support services in the home environment. However, there are considerable barriers to a widespread adoption of this technology. To gain a better understanding of the available technology and its associated strength, as well as weaknesses, we reviewed scientific papers that used various strategies for RM-based SA detection. Our review focused on 113 studies that were conducted between 2018 and 2022 and that were listed in Google Scholar. We found that just over 50% of the proposed RM systems incorporated real time signal processing and around 20% of the studies did not report on this important aspect. From an environmental perspective, this is a significant shortcoming, because 30% of the studies were based on measurement devices that must travel whenever the internal buffer is full. The environmental impact of that travel might constitute an additional need for changing from offline to online SA detection in the home environment.
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Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study. J Clin Med 2022; 11:jcm11154449. [PMID: 35956065 PMCID: PMC9369967 DOI: 10.3390/jcm11154449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
West Virginia (WV) has the highest rates of obesity and cardiopulmonary disease in the United States (U.S.). Recent work has identified a significant care gap in WV for obstructive sleep apnea (OSA). This OSA care gap likely has significant health implications for the region given the high rates of obesity and cardiopulmonary disease. The purpose of this mix methods study was to identify barriers that contribute to the rural OSA care disparity previously identified in WV. Methods: This study used mixed methods to evaluate the barriers and facilitators to management of OSA at Federally Qualified Health Centers serving communities in southern WV. Focus groups were conducted at federally qualified health centers with providers serving Appalachian communities. Participants also completed the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire to gain insight into provider knowledge and beliefs regarding OSA. EMR analysis using diagnostic codes was completed at the sites to assess OSA prevalence rates. The same individual served as the interviewer in all focus group sessions to minimize interviewer variability/bias. Our team checked to ensure that the professional transcriptions were correct and matched the audio via spot checks. Results: Themes identified from the focus groups fell into three broad categories: (1) barriers to OSA care delivery, (2) facilitators to OSA care delivery, and (3) community-based care needs to optimize management of OSA in the targeted rural areas. Questionnaire data demonstrated rural providers feel OSA is an important condition to identify but lack confidence to identify and treat OSA. Evaluation of the electronic medical record demonstrates an even larger OSA care gap in these rural communities than previously described. Conclusion: This study found a lack of provider confidence in the ability to diagnose and treat OSA effectively and identified specific themes that limit OSA care in the communities studied. Training directed toward the identified knowledge gaps and on new technologies would likely give rural primary care providers the confidence to take a more active role in OSA diagnosis and management. An integrated model of care that incorporates primary care providers, specialists and effective use of modern technologies will be essential to address the identified OSA care disparities in rural WV and similar communities across the U.S. Community engaged research such as the current study will be essential to the creation of feasible, practical, relevant and culturally competent care pathways for providers serving rural communities with OSA and other respiratory disease to achieve health equity.
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Donovan LM. Rural residence and adherence to continuous positive airway pressure therapy: have we overcome a barrier? J Clin Sleep Med 2022; 18:967-968. [PMID: 35105438 PMCID: PMC8974378 DOI: 10.5664/jcsm.9916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lucas M Donovan
- Veterans Affairs Puget Sound Health Care System, Seattle, WA.,University of Washington, Seattle, WA
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9
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Corrigan J, Tsai WH, Ip-Buting A, Ng C, Ogah I, Peller P, Sharpe H, Laratta C, Pendharkar SR. Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study. J Clin Sleep Med 2021; 18:1013-1020. [PMID: 34823649 DOI: 10.5664/jcsm.9776] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether adherence to continuous positive airway pressure (CPAP) in adults with uncomplicated OSA differs by rural versus urban residential address. METHODS In this prospective cohort study, we recruited adults who initiated CPAP for uncomplicated OSA that was diagnosed by a physician using sleep specialist-interpreted diagnostic testing. Participants were classified as urban (community size > 100,000) or rural by translating residential postal code into geographic census area. The primary outcome was mean daily hours of CPAP use compared between rural and urban patients. Secondary outcomes included: the proportion of patients who were adherent to CPAP; change in Epworth Sleepiness Scale (ESS) score; change in EuroQOL-5D score; and Visit-Specific Satisfaction Instrument score. All outcomes were measured three months after CPAP initiation. RESULTS We enrolled 242 patients (100 rural) with mean (SD) age 51 (13) years and respiratory event index 24 (18) events/hour. Mean (95% CI) CPAP use was 3.19 (2.8,3.58) hours/night and 35% were CPAP-adherent, with no difference between urban and rural patients. Among the 65% of patients who were using CPAP at three months, mean CPAP use was 4.89 (4.51,5.28) hours/night and was not different between rural and urban patients. Improvement in ESS and patient satisfaction were similar between groups, but EuroQOL-5D score improved to a greater extent in rural patients. Urban or rural residence was not associated with CPAP adherence in multivariable regression analysis. CONCLUSIONS Rural versus urban residence was not associated with differences in CPAP adherence when guided by specialist-interpreted diagnostic sleep testing.
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Affiliation(s)
- Jennifer Corrigan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Willis H Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ada Ip-Buting
- Ward of the 21st Century Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Imhokhai Ogah
- Department of Medicine, Queen's University, Kingston, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Canada
| | - Heather Sharpe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Cheryl Laratta
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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10
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Corrigan J, Ogah I, Ip-Buting A, Sharpe H, Laratta CR, Peller P, Tsai WH, Pendharkar SR. An evaluation of rural-urban disparities in treatment outcomes for obstructive sleep apnoea: study protocol for a prospective cohort study. ERJ Open Res 2020; 6:00141-2020. [PMID: 33043058 PMCID: PMC7534578 DOI: 10.1183/23120541.00141-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022] Open
Abstract
Background Obstructive sleep apnoea (OSA) is a common and treatable chronic condition that is associated with significant morbidity and economic cost. Geography is increasingly being recognised as a barrier to diagnosis and treatment of many chronic diseases; however, no study to date has investigated the impact of place of residence on health outcomes in OSA. Objective The purpose of this study is to determine whether treatment outcomes for patients initiating continuous positive airway pressure (CPAP) for OSA differ between those who live in urban versus rural settings. Methods A prospective cohort design will be used. Participants will be recruited through community-based CPAP providers and assigned to either the rural or urban cohort based on residential postal code. The primary outcome will be the difference in nightly hours of CPAP use between the two groups, measured 3 months after initiation of therapy. Secondary outcomes will include symptoms, quality of life, patient satisfaction and patient-borne costs. Anticipated results This study will determine whether there are differences in CPAP adherence or patient-reported outcomes between rural and urban patients with OSA. These results will highlight potential challenges with providing OSA care in rural populations and may inform health interventions to reduce urban-rural inequities.
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Affiliation(s)
- Jennifer Corrigan
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Imhokhai Ogah
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ada Ip-Buting
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather Sharpe
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl R Laratta
- Dept of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Canada
| | - Willis H Tsai
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Dept of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sachin R Pendharkar
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Dept of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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11
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Patel SR, Donovan LM. The COVID-19 Pandemic Presents an Opportunity to Reassess the Value of Polysomnography. Am J Respir Crit Care Med 2020; 202:309-310. [PMID: 32510968 PMCID: PMC7397790 DOI: 10.1164/rccm.202005-1546ed] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Sanjay R Patel
- Division of Pulmonary, Allergy, and Critical Care MedicineUniversity of PittsburghPittsburgh, Pennsylvania
| | - Lucas M Donovan
- Center of Innovation for Veteran-Centered and Value-Driven CareVA Health Services Research and DevelopmentSeattle, Washingtonand.,Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattle, Washington
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12
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Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology 2020; 25:690-702. [PMID: 32436658 DOI: 10.1111/resp.13838] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor for OSA, has risen in striking proportion worldwide. In the past 5 years, the WHO estimates global obesity to affect almost two billion adults. A second major risk factor for OSA is advanced age. As the prevalence of the ageing population and obesity increases, the vulnerability towards having OSA increases. In addition to these traditional OSA risk factors, studies of the global population reveal select contributing features and phenotypes, including extreme phenotypes and symptom clusters that deserve further examination. Untreated OSA is associated with significant comorbidities and mortality. These represent a tremendous threat to the individual and global health. Beyond the personal toll, the economic costs of OSA are far-reaching, affecting the individual, family and society directly and indirectly, in terms of productivity and public safety. A better understanding of the pathophysiology, individual and ethnic similarities and differences is needed to better facilitate management of this chronic disease. In some countries, measures of the OSA disease burden are sparse. As the global burden of OSA and its associated comorbidities are projected to further increase, the infrastructure to diagnose and manage OSA will need to adapt. The use of novel approaches (electronic health records and artificial intelligence) to stratify risk, diagnose and affect treatment are necessary. Together, a unified multi-disciplinary, multi-organizational, global approach will be needed to manage this disease.
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Affiliation(s)
- M Melanie Lyons
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Nitin Y Bhatt
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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