Sleep Disorders and Sleep Deprivation An Unmet Public Health Problem (2006) / Chapter Skim
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5 Improving Awareness, Diagnosis, and Treatment of Sleep Disorders
5 Improving Awareness, Diagnosis, and Treatment of Sleep Disorders
Pages 173-216
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From page 173... ...
There are a number of surveillance and monitoring tools, but very few examine issues pertaining to sleep loss and sleep disorders. Thus, third, improved surveillance and monitoring of the general population is needed.
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From page 174... ...
Thus, daytime sleepiness and its consequences are becoming increasingly common problems affecting up to 15 percent of the population (Punjabi et al., 2003)
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From page 175... ...
, and private foundations demonstrate a limited investment in education and awareness campaigns directed toward increasing the general public's knowledge of the health implications associated with chronic sleep loss and sleep disorders. National Center on Sleep Disorders Research Public Education Campaigns The NCSDR was established within the National Heart, Lung, and Blood Institute (NHLBI)
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From page 176... ...
Private Foundations Education and Awareness Campaigns Although limited, private foundations and professional societies, and to a lesser extent patient advocacy organizations, have developed a number of public education programs. A highly successful example is the National Sleep Foundation's (NSF)
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From page 177... ...
Compliance Campaign, establishing accreditation programs for sleep technologists and behavioral sleep medicine training programs, and assisting in the development of new clinical practice guidelines. Other private organizations such as the American Sleep Apnea Association, Restless Legs Syndrome Foundation, and Academy of Dental Sleep Medicine have also created smaller public education tools such as patient education brochures, support groups, and online videos.
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From page 178... ...
For example, 80 to 90 percent of obstructive sleep apnea cases remain undiagnosed, which increases the burden of this disorder (Young et al., 1997; Kapur et al., 2002)
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From page 179... ...
In addition, the committee envisions that the campaign should be developed in coordination with the NCSDR, CDC, the proposed National Somnology and Sleep Medicine Research and Clinical Network (see Chapter 8) , the Department of Transportation, the Department of Labor, the Department of Education, other relevant federal departments and agencies, with input from private organizations such as the NSF and the AASM.
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From page 180... ...
In summary, although evidence is limited, previously coordinated health education campaigns demonstrate the potential value of efforts designed to increase the awareness of both the prevalence and consequences of chronic sleep loss and sleep disorders. For example, broad coordinated national campaigns such as the NHLBI's National High Blood Pressure Campaign (Roccella, 2002)
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From page 181... ...
National High Blood Pressure Education Campaign Another successful public education program is the National High Blood Pressure Education Program. It was established by the NHLBI in 1972 "to reduce death and disability related to high blood pressure through programs of professional, patient, and public education" (NHLBI, 2005a)
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From page 182... ...
PROFESSIONAL TRAINING AND AWARENESS IS REQUIRED Societal misperceptions also stem from a lack of professional knowledge about the benefits and impact of sleep. Therefore, the success of the proposed National Sleep Public Education Awareness Campaign particularly relies on increased awareness and more sleep-oriented curricula for the health care providers.
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From page 183... ...
For example, individuals with obstructive sleep apnea (OSA) typically require recognition by a primary care physician, and diagnosis and treatment from a sleep specialist who is a pulmonologist, neurologist, psychiatrist, or otolaryngologist.
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From page 184... ...
. Chronic Sleep Loss and Sleep Disorders Awareness Programs for Undergraduates Although some sleep-related public health educational activities have been developed (see previous section)
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From page 185... ...
Undergraduate Somnology and Sleep Medicine Curriculum Development Colleges and universities can both educate students and stimulate interest in the field by making simple cost-effective changes in curriculum. For example, at the United States Military Academy, the general psychology course that is taken by all freshmen now includes information on acute and chronic sleep loss (Miller and Shattuck, 2005)
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From page 186... ...
Another individual recently received a young investigator award from the European Sleep Research Society (2004, Prague ESRS meeting) for research on adolescent sleep patterns.
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From page 187... ...
Although there are limited data, it appears that this exposure does not occur. For example, one of the top neuroscience and sleep programs, the neuroscience graduate course in the health sciences and technology program at Harvard University and Massachusetts Institute of Technology, includes only a single lecture on the molecular biology of circadian rhythms and no exposure to sleep-related research (personal communication, C.B.
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From page 188... ...
Major barriers continue to be lack of time in the medical curriculum, the need for better resources and teaching facilities, and the need for leadership and effective advocacy. Barriers to Implementation of Sleep-Related Medical Curriculum Efforts to enhance the training and education in somnology and sleep medicine at all levels of medical education continue to face important challenges.
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From page 189... ...
In tandem with curricular development, the Sleep Academic Award program also sought to promote interdisciplinary learning environments and faculty development in somnology and sleep medicine. The model curriculum for medical schools encompassed these four basic core competencies: · Explain the nature and causation of sleep.
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From page 190... ...
. · The use of the objective structured clinical examination for sleep medicine to gain access to the medical school curriculum by providing objective structured clinical examinations on sleep problems such as obstructive sleep apnea and chronic insomnia (Rosen et al., 2005)
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From page 191... ...
However, except for residency programs in otolaryngology, none of the other four residency program requirements address clinical experiences in sleep medicine (ACGME, 2005a)
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Exposure of residents to discovery and translational research related to sleep medicine might also enhance the attractiveness of the field. Therefore, somnology and sleep medicine investigators should participate, wherever possible, in the residency training process.
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TABLE 5-1 Accredited Programs for Fellowship Training in Somnology and Sleep Medicine Date Department Accredited Name of Institution Affiliation 1980 Stanford University Psychiatry and Behavioral Sciences 1989 Center for the Study of Sleep and Waking Psychiatry and Behavioral Sciences 1991 Detroit Veterans Affairs Medicinal Center Neurology 1991 Henry Ford Hospital Pulmonary Division 1992 Mount Sinai Sleep Disorders Center Pulmonary Division 1993 Michael S Aldrich Sleep Disorders Laboratory Neurology and Psychiatry 1993 Newark Beth Israel Sleep Disorders Center Department of Pulmonary Medicine 1993 University of Pittsburgh School of Medicine Psychiatry and Medicine, Pulmonary Division 1994 Cleveland Clinic Foundation Neurology 1995 Mayo Sleep Disorders Center Pulmonary and Critical Care 1996 Rush University Medical Center Departments of Psychology and Medicine 1997 Wayne State University Pulmonary Division 1998 University of Kentucky Internal Medicine 1998 University of Mississippi Medical Center Psychiatry 1998 Intermountain Sleep Disorders Center Pulmonary Division 1999 Children's Memorial Hospital Pediatrics 2000 Brigham and Women's Hospital Medicine 2000 Duke University Medical Center Pulmonary, Clinical Neurology, and Clinical Neuropatholgy continued
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Elizabeth's Medical Center Pulmonary Division, Department of Medicine 2002 Long Island Jewish Medical Center Department of Medicine 2002 New Mexico Center for Sleep Medicine 2002 University of Iowa Hospitals and Clinics Sleep Neurology Disorder Center 2002 Hackensack University Medical Center Institute of Sleep-Wake Disorders 2002 Dartmouth Hitchcock Medical Center Department of Psychiatry 2003 Mayo Clinic/Mayo Graduate School of Medicine, Division of Education Jacksonville Services 2003 Johns Hopkins University Sleep Disorders Center Pulmonary/Critical Care
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From page 195... ...
The first design allowed for the sleep medicine fellowship to be a minimum of 12 months of training in comprehensive sleep medicine that could be done during or after specialty fellowship training. The second design allowed for the sleep medicine fellowship to be of a combined nature, in
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The ACGME fellowship requires 1 year of clinical sleep medicine. Trainees can enter the sleep medicine fellowship if they have been trained in one of the following: general internal medicine (3 years of postgraduate training)
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DEMONSTRATION OF KNOWLEDGE: BOARD CERTIFICATION ABSM Certification In response to increasing recognition and awareness of the importance of sleep and sleep disorders, professional certification in sleep medicine has been administered for physicians and practitioners to demonstrate skill and competence. The American Sleep Disorders Association (now the AASM)
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From page 198... ...
In March 2005, the ABMS announced approval of the certification examination in sleep medicine. A specific time frame for the new examination has not been set; it is expected, however, that the first examination cycle will begin in 2007.
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Although this new structure is based on sleep medicine becoming recognized as an independent specialty, it is too early to tell how well this new approach will work in developing the needed workforce of practitioners for sleep medicine and the next generation of physician-scientists. The fellowship is somewhat unusual in that there is only the requirement for 1 year of training beyond completion of residency.
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. As described in detail in Chapter 8, the committee encourages the proposed Type II comprehensive academic sleep centers to incorporate research training into their sleep medicine fellowships, while for Type III centers this is considered an essential component.
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NEXT STEPS Medical, nursing, and pharmacy students along with individuals in graduate training, residency, and fellowship training programs require greater exposure to the public health burden of sleep loss and disorders; they also must understand the relationship between sleep problems and the proper diagnosis and treatment of a wide range of medical problems throughout an individual's life span. Although the data are limited, they suggest that focused training about sleep can positively influence the performance of medical students (Haponik and Camp, 1994)
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Recommendation 5.2: Academic health centers should integrate the teaching of somnology and sleep medicine into baccalaureate and doctoral health sciences programs, as well as residency and fellow ship training and continuing professional development programs. The subjects of sleep loss and sleep disorders should be included in the curricula of relevant baccalaureate and graduate educational and research programs of all the health sciences.
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. As described below, data relevant to sleep research are currently available from some of these systems, but the possibility of additional data collection to fill current knowledge gaps should be carefully considered.
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From page 204... ...
NHANES monitors the prevalence of diseases and risk factors, nutritional habits and anthropometry status, growth and development, and environmental exposures. Because of its cyclical nature, in addition to its core components, NHANES temporarily adds components (either additional questionnaires or exam procedures)
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Sleep apnea? Insomnia?
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From page 206... ...
Based on these data, the percentage of adults who reported sleeping 6 hours or less jumped from approximately 20 percent of the population in 1985 (Schoenborn, 1986) to 25 percent in 2004 (National Center for Health Statistics, National Health Interview Survey, 2004)
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IMPROVING AWARENESS, DIAGNOSIS, AND TREATMENT 207 TABLE 5-3 Surveys Included in the National Health Care Survey's System National Ambulatory Medical Care Survey National Employer Health Insurance Survey National Health Provider Inventory National Home and Hospice Care Survey National Hospital Ambulatory Medical Care Survey National Hospital Discharge Survey National Nursing Home Survey National Survey of Ambulatory Surgery Two of the participating surveys are of particular relevance for the study of health care resources utilization in relation to sleep disorders: the National Ambulatory Medical Care Survey and the National Hospital Discharge Survey. The National Ambulatory Medical Care Survey The National Ambulatory Medical Care Survey, which has been conducted annually since 1989, is a national survey designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States.
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From page 208... ...
As an example of the amount of data available in this survey, the estimated number of all listed sleep disorders diagnoses in NHDS in 2003 was 322,000. Although the NHDS excludes information obtained through VA hospitals, there is a similar database provided by the VA that has been used to examine the association of psychiatric disorders and sleep apnea (Sharafkhaneh et al., 2005)
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From page 209... ...
There are currently no sleep-related questions in Behavioral Risk Factor Surveillance System. Medical Expenditure Panel Survey Funded by the Agency for Healthcare Research and Quality, the Medical Expenditure Panel Survey is a national probability survey designed to continually provide policy makers, health care administrators, businesses, and others with timely, comprehensive information about health care use and costs in the United States, and to improve the accuracy of their economic projections.
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From page 210... ...
Despite the importance of sleep deprivation and other sleep disorders in young adolescents (see Chapter 3) , no questions on sleep and sleep behaviors have ever been included in the survey.
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IMPROVING AWARENESS, DIAGNOSIS, AND TREATMENT 211 following is a description of the criteria for adding components or questions to NHANES. Other surveys and monitoring instruments have similar requirements.
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2004. Factors limiting access to services for sleep apnea patients.
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2002. Underdiagnosis of sleep apnea syndrome in U.S.
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2005. The effects of an intervention to teach medical students about obstructive sleep apnea.
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From page 215... ...
2005. Association of psychiatric disorders and sleep apnea in a large cohort.
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