Page 15 - Layout 1

SLEEP
MEDICINE

umenting bedtimes, sleep time, awakening times, variations in sleep pe- a primary disorder and is also linked with many other conditions, such
riods, nap times, and use of sleep effecting substances such as caffeine, as Parkinson’s disease. Any concern for neurological disease should be
tobacco, stimulants, alcohol, opioids as well as environmental factors referred to a Sleep Specialist or Neurologist for further evaluation.
that can affect the sleep period. In summary, all of us want to feel rested and refreshed from our sleep.
Clearly, sleep disordered breathing (Obstructive Sleep Apnea, Cen- All of our patients know that we can’t survive without sleep, but often
tral Sleep Apnea, Nocturnal Hypoventilation) has become the poster sacrifice sleep because of different priorities. However, there is a grow-
child of sleep disorders over the past 15 years, with a population ing reawakening to the importance of sleep as witnessed by the new
prevalence between 2-26 percent, depending on subgroup definition. revolution in multiple commercial sleep monitors and their increasing
Increased community recognition, better understanding of the inter- use. We have the opportunity to encourage our patients to improve
play with heart disease, as well as the general increase in obesity preva- their sleep health, and to be aware of potential sleep disorders that may
lence has brought this to the fore. It is difficult to watch TV for interfere with health. The Primary Care physician is the key link in our
longer than an hour or two and not see an advertisement for some system in improving health and preventing disease. With that in mind,
form of OSA treatment. The progressive effects of OSA over time on perhaps we should start with ourselves, improving our own sleep habits
heart disease patients has resulted in greater efforts to diagnose and and ensuring that we are treated for any sleep disorders we may have.
treat OSA. The high prevalence of OSA has now pushed diagnosis Getting the best sleep of our lives will enable us to provide the best care
and treatment for these patients into the Primary Care office. Patients to those who come to us for assistance.
typically present for evaluation with snoring, excessive sleepiness or
insomnia, sore throats, morning headaches, night sweats and wit- References:
nessed apnea. The simple STOP-BANG questionnaire has great sen- 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10416725/
sitivity with scores > 3 (snoring, tiredness, observed apnea, pressure 2. Buysse DJ, et al. The Pittsburgh Sleep Quality Index: a new instru-
high, BMI>35, Age >50, neck circumference > 40 cm, gender = ment for psychiatric practice and research. Psychiatry research
male), and indicate a need for objective testing. In patients without 1989:28(2);193-213
co-morbidities, or only mild concomitant illnesses, home sleep stud- 3. https://www.sleepprimarycareresources.org.au/insomnia/assess-
ies are effective in diagnosing OSA. Several local and national services ment-questionnaires
offer these studies with the option of continuing to manage these pa- 4. Lettieri CJ, Eliasson AH, Andrada T, Khramtsov A, Raphaelson M,
tients in the Primary Care setting or referring them to the Sleep Spe- Kristo DA. Obstructive sleep apnea syndrome: are we missing an at-
cialist. Reports from these services frequently return with treatment risk population? J Clin Sleep Med. 2005;1:381–5.
recommendations, particularly for Auto-titrating CPAP, which can 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9373878/
be easily prescribed and serves to adjust each night to patient envi- 6. https://www.bjanaesthesia.org/article/S0007-0912(17)32225-
ronmental and physiological variation. Patients with poorly con- 0/fulltext
trolled heart or lung disease, neurological deficits, or those at 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402728/
significant risk for central apnea or hypoventilation, need to be re- 8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402728/
ferred for in-lab monitored testing due to their increased risks of dys- 9. https://aasm.org/one-in-three-americans-have-used-electronic-
rhythmia and gas exchange abnormalities. Patients who are diagnosed sleep-trackers-leading-to-changed-behavior-for-many/
with complex sleep disorders or are poorly responsive to first level
treatment should likely be followed by a Sleep Specialist. James H. Henderson II, MD, FCCP, FAASM, is a Board-Cer-
Those patients who do report unusual sounds or movements at night tified Pulmonology/Critical Care/Sleep Medicine physician with
(parasomnias) have a broad diagnostic differential, several of which are over 30 years of experience in executive leadership, clinical, aca-
neurological in nature. Often, unusual seizure disorders must be con- demic and military medicine, residency program directorship and medical
sidered and ruled out. Parasomnias may also be associated with nutri- administration. He is a former Clinical Director and Sleep Fellowship Di-
tional deficiencies, anemia and hypothyroidism. Some of these rector of the largest sleep medicine facility in the Department of Defense
disorders such as Sleepwalking or Night Terrors are often treated in Pri- and former Chairman of the largest pulmonary and respiratory depart-
mary Care, many times jointly with a Sleep Specialist. The most com- ment in the U.S. Air Force. Dr. Henderson is a member of the Bexar
mon parasomnia that is cared for in Primary Care is Restless Legs County Medical Society.
Syndrome, which has a strong correlation with anemia but may also be

Visit us at www.bcms.org 15