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Sleep Disorders Management in Primary Care

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Nursing".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 28584

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Dr. Izolde Bouloukaki

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Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
Interests: COPD; sleep apnoea; sleep disorders; asthma smoking cessation; primary care

Special Issue Information

Dear Colleagues,

Sleep disorders are highly prevalent disorders associated with motor vehicle accidents, impaired cognition, metabolic syndrome, impaired immune function, altered mood, decreased quality of life, and increased mortality. The most common sleep disorders seen in primary care settings are insomnia, obstructive sleep apnea, and restless legs syndrome. The high prevalence of undiagnosed sleep disorders and its complications for health require improved routine screening and assessment in primary care settings. However, the current practice model of screening and assessment for sleep disorders is fragmented and ineffective, which is attributable not only to lack of use of screening instruments, but also to lack of routinely eliciting relevant symptoms. Identification by primary care practitioners of patients who are at high risk for sleep disorders could significantly reduce their frequency and improve the quality of life and health outcomes for these patients.

In light of these data, this Special Issue is soliciting manuscripts addressing topics related to the evaluation and management of sleep disorders and its symptoms in the primary care setting. Original articles, commentaries, and reviews on the prevalence, screening, evaluation, and diagnostic strategies of sleep disorders in primary care, as well as on the evaluation of the risk factors, natural history, and consequences of sleep disorders, and on the topics of management and treatment options available will be considered.

The aim of the Special Issue is to provide updated information of the current screening, diagnosis, and management of sleep disorders in primary care settings. Additional research to identify potential barriers to effectively addressing sleep disorders, to improve the diagnostic accuracy of screening tools and the provision of sleep services in primary care are particularly welcome.

Dr. Izolde Bouloukaki
Guest Editor

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Keywords

sleep disorders
insomnia
sleep quality
obstructive sleep apnea
restless legs syndrome
routine screening and assessment
sleep services
primary care

Published Papers (9 papers)

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Research

13 pages, 1250 KiB

Open AccessArticle

Sleep Habits, Academic Performance and Health Behaviors of Adolescents in Southern Greece

by Christina Alexopoulou, Maria Fountoulaki, Antigone Papavasileiou and Eumorfia Kondili

Healthcare 2024, 12(7), 775; https://doi.org/10.3390/healthcare12070775 - 03 Apr 2024

Viewed by 520

Abstract

Adolescents often experience insufficient sleep and have unhealthy sleep habits. Our aim was to investigate the sleep patterns of secondary education students in Heraklion, Crete, Greece and their association with school performance and health habits. We conducted a community-based cross-sectional study with 831 students aged 13–19 years who completed an online self-reported questionnaire related to sleep and health habits. The data are mostly numerical or categorical, and an analysis was performed using t-tests, chi-square tests and multiple logistic regression. During weekdays, the students slept for an average of 7 ± 1.1 h, which is significantly lower than the 7.8 ± 1.5 h average on weekends (p < 0.001). Nearly 79% reported difficulty waking up and having insufficient sleep time, while 73.8% felt sleepy at school at least once a week. Having sufficient sleep time ≥ 8 h) was positively correlated with better academic performance (OR: 1.48, CI: 1.06–2.07, p = 0.022) and frequent physical exercise (never/rarely: 13.5%, sometimes: 21.2%, often: 65.3%; p = 0.002). Conversely, there was a negative correlation between adequate sleep and both smoking (OR: 0.29, CI: 0.13–0.63) and alcohol consumption (OR: 0.51, CI: 0.36–0.71, p = 0.001). In conclusion, this study shows that students in Heraklion, Crete frequently experience sleep deprivation, which is associated with compromised academic performance, reduced physical activity and an increased likelihood of engaging in unhealthy behaviors like smoking and alcohol consumption. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

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9 pages, 225 KiB

Open AccessArticle

Sleepiness and Vitamin D Levels in Patients with Obstructive Sleep Apnea

by Kostas Archontogeorgis, Nicholas-Tiberio Economou, Panagiotis Bargiotas, Evangelia Nena, Athanasios Voulgaris, Konstantina Chadia, Georgia Trakada, Andrea Romigi and Paschalis Steiropoulos

Healthcare 2024, 12(6), 698; https://doi.org/10.3390/healthcare12060698 - 21 Mar 2024

Viewed by 993

Abstract

Study Objectives: The aim of this cross-sectional study is to explore the association between serum 25-hydroxyvitamin D [25(OH)D] levels, a marker of Vitamin D status, and excessive daytime sleepiness (EDS), expressed as increased scores of the Epworth Sleepiness Scale (ESS), in a group of prospectively enrolled patients with obstructive sleep apnea (OSA). Methods: Newly diagnosed patients with OSA, divided into two groups, those with EDS (ESS > 10) and those without EDS (ESS < 10). All patients underwent night polysomnography. Measurement of serum 25(OH)D vitamin was performed using a radioimmunoassay. Results: In total, 217 patients with OSA (197 males and 20 females) were included. Patients with EDS had higher AHI (p < 0.001) values and lower mean serum 25(OH)D levels, compared with those of non-somnolent patients [17.4 (12.2–25.7) versus 21.1 (15.3–28.8) ng/mL, respectively, p = 0.005]. In patients with EDS, serum 25(OH)D levels correlated with average oxyhemoglobin saturation during sleep (r = 0.194, p = 0.043), and negatively with ESS score (r = −0.285, p = 0.003), AHΙ (r = −0.197, p = 0.040) and arousal index (r = −0.256, p = 0.019). Binary regression analysis identified Vit D serum levels (β = −0.045, OR: 0.956, 95% CI: 0.916–0.997, p = 0.035), total sleep time (β = 0.011, OR: 1.011, 95% CI: 1.002–1.021, p = 0.016) and AHI (β = 0.022, OR: 1.022, 95% CI: 1.003–1.043, p = 0.026) as independent predictors of EDS in patients with OSA. In patients with EDS, multiple regression analysis indicated that ESS score was negatively associated with Vit D serum levels (β = −0.135, p = 0.014) and minimum oxyhemoglobin saturation during sleep (β = −0.137, p = 0.043). Conclusions: In the present study, EDS in patients with OSA is associated with low levels of Vitamin D, while sleep hypoxia may play a role in this process. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

11 pages, 292 KiB

Open AccessArticle

Sleep Quality and Fatigue during Exam Periods in University Students: Prevalence and Associated Factors

by Izolde Bouloukaki, Ioanna Tsiligianni, Giorgos Stathakis, Michail Fanaridis, Athina Koloi, Ekaterini Bakiri, Maria Moudatsaki, Eleptheria Pouladaki and Sophia Schiza

Healthcare 2023, 11(17), 2389; https://doi.org/10.3390/healthcare11172389 - 25 Aug 2023

Cited by 1 | Viewed by 2102

Abstract

The aim of our study was to assess university students’ sleep quality and fatigue before and during the academic exam period and identify potential associated factors. A Web-based survey was completed by 940 students of 20 different Tertiary Institutions including demographics, sleep habits, exercise, caffeine, tobacco, alcohol use, subjective sleep quality (Pittsburgh Sleep Quality Index—PSQI), and fatigue (Fatigue severity scale—FSS) at the beginning of the semester and during the examination period. During the exam period, PSQI (8.9 vs. 6.1, p < 0.001) and FSS scores (36.9 vs. 32.7, p < 0.001) were significantly elevated compared to the pre-exam period. An increase in the PSQI score was associated with age (β = 0.111, p = 0.011), presence of chronic disease (β = 0.914, p = 0.006), and depressive symptoms (β = 0.459, p = 0.001). An increase in the FSS score was associated with female gender (β = 1.658, p < 0.001), age, (β = 0.198, p = 0.010), increase in smoking (β = 1.7, p = 0.029), coffee/energy drinks consumption (β = 1.988, p < 0.001), decreased levels of physical exercise (β = 1.660, p < 0.001), and depressive symptoms (β = 2.526, p < 0.001). In conclusion, our findings indicate that exam periods have a negative impact on the sleep quality and fatigue levels of university students. Potential factors were identified that could contribute to the formulation of strategies for improved sleep quality and wellness. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

14 pages, 276 KiB

Open AccessArticle

Smoking-Induced Disturbed Sleep. A Distinct Sleep-Related Disorder Pattern?

by Ioanna Grigoriou, Paschalia Skalisti, Ioanna Papagiouvanni, Anastasia Michailidou, Konstantinos Charalampidis, Serafeim-Chrysovalantis Kotoulas, Konstantinos Porpodis, Dionysios Spyratos and Athanasia Pataka

Healthcare 2023, 11(2), 205; https://doi.org/10.3390/healthcare11020205 - 10 Jan 2023

Cited by 2 | Viewed by 2198

Abstract

The relationship between smoking and sleep disorders has not been investigated sufficiently yet. Many aspects, especially regarding non-obstructive sleep apnea–hypopnea (OSA)-related disorders, are still to be addressed. All adult patients who visited a tertiary sleep clinic and provided information about their smoking history were included in this cross-sectional study. In total, 4347 patients were divided into current, former and never smokers, while current and former smokers were also grouped, forming a group of ever smokers. Sleep-related characteristics, derived from questionnaires and sleep studies, were compared between those groups. Ever smokers presented with significantly greater body mass index (BMI), neck and waist circumference and with increased frequency of metabolic and cardiovascular co-morbidities compared to never smokers. They also presented significantly higher apnea–hypopnea index (AHI) compared to never smokers (34.4 ± 24.6 events/h vs. 31.7 ± 23.6 events/h, p < 0.001) and were diagnosed more frequently with severe and moderate OSA (50.3% vs. 46.9% and 26.2% vs. 24.8% respectively). Epworth sleepiness scale (ESS) (p = 0.13) did not differ between groups. Ever smokers, compared to never smokers, presented more frequent episodes of sleep talking (30.8% vs. 26.6%, p = 0.004), abnormal movements (31.1% vs. 27.7%, p = 0.021), restless sleep (59.1% vs. 51.6%, p < 0.001) and leg movements (p = 0.002) during sleep. Those were more evident in current smokers and correlated significantly with increasing AHI. These significant findings suggest the existence of a smoking-induced disturbed sleep pattern. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

10 pages, 610 KiB

Open AccessArticle

Knowledge and Attitude towards Obstructive Sleep Apnea among Primary Care Physicians in Northern Regions of Saudi Arabia: A Multicenter Study

by Abdullah N. Al-Rasheedi, Ashokkumar Thirunavukkarasu, Abdulhakeem Almutairi, Sultan Alruwaili, Hatem Alotaibi, Wasan Alzaid, Faisal Albalawi, Osama Alwadani and Ahmed Dilli

Healthcare 2022, 10(12), 2369; https://doi.org/10.3390/healthcare10122369 - 25 Nov 2022

Cited by 4 | Viewed by 1692

Abstract

Obstructive sleep apnea (OSA) is a serious and often underreported condition, despite its highly prevalent distribution. Primary care physicians (PCPs) play an integral role in screening and managing patients with a high risk of developing OSA. This northern Saudi Arabian cross-sectional survey assessed the knowledge and attitude towards OSA among 264 randomly selected PCPs using the OSA Knowledge and Attitude (OSAKA) questionnaire. Among the participating PCPs, 43.9% and 45.1% had low scores in the knowledge and attitude categories, respectively. More than three-fourths (78%) of them recognized that an overnight sleep study is the gold standard for diagnosing OSA. Regarding referral, 39.4% of the OSA patients encountered by the PCPs were referred to ENT specialists, while 21% were referred to sleep clinics, and 18.2% were referred to pulmonologists. Nearly half (50.8%) of the participants recognized OSA as an important clinical disease, and 56.8% were confident in caring for OSA patients. Spearman’s correlation of the current study identified a positive correlation between knowledge scores and attitude scores (rho—0.151, p = 0.017). It is important to improve PCPs’ knowledge regarding OSA and the necessity for referral through different training methods. Furthermore, the study findings emphasize the need to include appropriate OSA programs and continuing medical education for PCPs. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

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8 pages, 1548 KiB

Open AccessArticle

The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea: A Preliminary Study

by Yi-Chieh Lee, Chun-Ting Lu, Wen-Nuan Cheng and Hsueh-Yu Li

Healthcare 2022, 10(9), 1755; https://doi.org/10.3390/healthcare10091755 - 13 Sep 2022

Cited by 6 | Viewed by 14434

Abstract

Background: Many patients with obstructive sleep apnea (OSA) are mouth-breathers. Mouth-breathing not only narrows the upper airway, consequently worsening the severity of OSA, but also it affects compliance with nasal continuous positive airway pressure (CPAP) treatment. This study aimed to investigate changes in OSA by the use of mouth tape in mouth-breathers with mild OSA. Method: Mouth-breathers with mild OSA who met inclusion criteria and tolerated the sealing of the mouth were enrolled in the study. We used 3M silicone hypoallergenic tape was used to seal the mouths of the participants during sleep. The home sleep test (HST) used in this study was ApneaLink^®. Subjects received both a baseline HST and an outcome HST to be used 1 week later while their mouths were taped. The changes between the baseline and the outcome HSTs were compared, and the factors that influenced the differences in the sleep-test parameters after the shift of the breathing route were analyzed. A “responder” was defined as a patient who experienced a reduction from the baseline snoring index of at least 50% under mouth-taping in the HST; otherwise, patients were considered as having a poor response. Results: A total of 20 patients with mild OSA were included. Following the taping of the mouth, a good response was found in 13 patients (65%). The median apnea/hypopnea index (AHI) decreased significantly, from 8.3 to 4.7 event/h (by 47%, p = 0.0002), especially in supine AHI (9.4 vs. 5.5 event/h, p = 0.0001). The median snoring index (SI) was also improved (by 47%, 303.8 vs. 121.1 event/h, p = 0.0002). Despite no significant difference in the mean saturation, improvements in the oxygen desaturation index (8.7 vs. 5.8, p = 0.0003) and the lowest saturation (82.5% vs. 87%, p = 0.049) were noted. The change in AHI was associated with baseline AHI (r = −0.52, p = 0.02), oxygen desaturation index (ODI) (r = −0.54, p = 0.01), and SI (r = −0.47, p = 0.04). The change in SI was strongly associated with baseline SI (r = −0.77, p = 0.001). Conclusions: Mouth-taping during sleep improved snoring and the severity of sleep apnea in mouth-breathers with mild OSA, with AHI and SI being reduced by about half. The higher the level of baseline AHI and SI, the greater the improvement was shown after mouth-taping. Mouth-taping could be an alternative treatment in patients with mild OSA before turning to CPAP therapy or surgical intervention. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

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17 pages, 328 KiB

Open AccessArticle

Sleep Disorders and Mental Stress of Healthcare Workers during the Two First Waves of COVID-19 Pandemic: Separate Analysis for Primary Care

by Athanasia Pataka, Seraphim Kotoulas, Asterios Tzinas, Nectaria Kasnaki, Evdokia Sourla, Evangelos Chatzopoulos, Ioanna Grigoriou and Paraskevi Argyropoulou

Healthcare 2022, 10(8), 1395; https://doi.org/10.3390/healthcare10081395 - 26 Jul 2022

Cited by 3 | Viewed by 1943

Abstract

Background: During the recent pandemic, Healthcare Professionals (HCPs) presented a significant prevalence of psychological health problems and sleep disturbances. The aim of this study was to assess the impact of COVID-19 on HCPs’ sleep and mental stress with a separate analysis for primary care HCPs. Methods: A cross-sectional observational study with an online anonymized, self-reported questionnaire was conducted in May 2020 (1st wave) and repeated in December 2020 (2nd wave). Patient health questionnaire-4 (PHQ-4), dimensions of anger reactions-5 (DAR-5) scale, 3-item UCLA loneliness scale (LS) and sleep condition indicator (SCI) were used. Results: Overall, 574 participants were included from the 1st wave, 514 from the 2nd and 469 were followed during both. Anxiety and depression were significantly higher during the 2nd wave vs. the 1st (32.8% vs. 12.7%, p < 0.001 and 37.7% vs. 15.8%, p < 0.001). During the 2nd wave, HCPs scored significantly higher in DAR-5 (9.23 ± 3.82 vs. 7.3 ± 3.3, p < 0.001) and LS (5.88 ± 1.90 vs. 4.9 ± 1.9, p < 0.001) with worse sleep quality SCI (23.7 ± 6.6 vs. 25.4 ± 3.2, p < 0.001). This was more evident in primary care HCPs. Significant correlations were found between SCI and PHQ4, DAR5 and LS. Conclusion: There is a need to support HCPs’ mental health and sleep, especially in those working in primary care. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

10 pages, 248 KiB

Open AccessArticle

Obstructive Sleep Apnea Syndrome Comorbidity Phenotypes in Primary Health Care Patients in Northern Greece

by Panagiota K. Ntenta, Georgios D. Vavougios, Sotirios G. Zarogiannis and Konstantinos I. Gourgoulianis

Healthcare 2022, 10(2), 338; https://doi.org/10.3390/healthcare10020338 - 10 Feb 2022

Cited by 1 | Viewed by 1275

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is a significant public health issue. In the general population, the prevalence varies from 10% to 50%. We aimed to phenotype comorbidities in OSAS patients referred to the primary health care (PHC) system. Methods: We enrolled 1496 patients referred to the PHC system for any respiratory- or sleep-related issue from November 2015 to September 2017. Some patients underwent polysomnography (PSG) evaluation in order to establish OSAS diagnosis. The final study population comprised 136 patients, and the Charlson comorbidity index was assessed. Categorical principal component analysis and TwoStep clustering was used to identify distinct clusters in the study population. Results: The analysis revealed three clusters: the first with moderate OSAS, obesity and a high ESS score without significant comorbidities; the second with severe OSAS, severe obesity with comorbidities and the highest ESS score; and the third with severe OSAS and obesity without comorbidities but with a high ESS score. The clusters differed in age (p < 0.005), apnea–hypopnea index, oxygen desaturation index, arousal index and respiratory and desaturation arousal index (p < 0.001). Conclusions: Predictive comorbidity models may aid the early diagnosis of patients at risk in the context of PHC and pave the way for personalized treatment. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

16 pages, 732 KiB

Open AccessArticle

Poor Diet, Long Sleep, and Lack of Physical Activity Are Associated with Inflammation among Non-Demented Community-Dwelling Elderly

by Maria Basta, Christina Belogianni, Mary Yannakoulia, Ioannis Zaganas, Symeon Panagiotakis, Panagiotis Simos and Alexandros N. Vgontzas

Healthcare 2022, 10(1), 143; https://doi.org/10.3390/healthcare10010143 - 12 Jan 2022

Cited by 4 | Viewed by 2325

Abstract

Inflammation in elderly is associated with physical and cognitive morbidity and mortality. We aimed to explore the association of modifiable lifestyle parameters with inflammation among non-demented, community-dwelling elderly. A sub-sample of 117 patients with mild cognitive impairment (MCI, n = 63) and cognitively non-impaired controls (CNI, n = 54) were recruited from a large, population-based cohort in Crete, Greece, of 3140 elders (>60 years old). All participants underwent assessment of medical history/physical examination, extensive neuropsychiatric/neuropsychological evaluation, diet, three-day 24-h actigraphy, subjective sleep, physical activity, and measurement of IL-6 and TNFα plasma levels. Associations between inflammatory markers and diet, objective sleep duration, subjective sleep quality, and lack of physical activity were assessed using multivariate models. Regression analyses in the total group revealed significant associations between TNF-α and low vegetable consumption (p = 0.003), and marginally with objective long nighttime sleep duration (p = 0.04). In addition, IL-6 was associated with low vegetable consumption (p = 0.001) and lack of physical activity (p = 0.001). Poor diet and lack of physical activity appear to be modifiable risk factors of inflammation, whereas long sleep appears to be a marker of increased inflammatory response in elderly. Our findings may have clinical implications given the association of inflammatory response with morbidity, including cognitive decline, and mortality in elderly. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care)

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