Sleep Histories Are Seldom Documented
Sleep Histories Are Seldom Documented
Background. Sleep disorders are common, but the frequency of sleep history documentation in hospitalized patients is unknown.
Methods. We reviewed 442 initial histories and physical examinations recorded by 122 house officers and 47 medical students in 208 consecutive general medicine ward patients.
Results. Any reference to sleep was recorded in only 18 patients (9%), including 12 of 141 (9%) with conditions associated with obstructive sleep apnea. Sleep histories were recorded more often in women (13% vs 4%) and less often than histories of cigarette smoking or alcohol use. Medical students recorded such histories more often than did house officers. Patients with sleep histories more often had pulse oximetry (78% vs 37%), pulmonary function testing (11% vs 1%), arterial blood gas analysis (67% vs 30%), or electrocardiograms (78% vs 49%).
Conclusions. Sleep histories are documented infrequently in hospitalized patients. Patients with a recorded sleep history more often have tests that suggest increased concerns about cardiorespiratory risk and/or a different process of care.
Sleep disorders affect approximately 12% of the population and have been associated with reduced quality of life, motor vehicle accidents, and other catastrophes. Sleep-disordered breathing, such as obstructive sleep apnea (OSA), has been estimated to affect approximately 2% to 4% of adults and has been associated with hypertension, cardiovascular disorders, stroke, and mortality. Because approximately 80% to 90% of clinically significant OSA cases are not recognized, the recognition and treatment of sleep disorders should be a priority of health professionals. Sleep histories might help physicians and other health professionals to identify potentially treatable conditions, but the frequency with which the sleep history essential to diagnosis is done in an acute care setting is unknown. In ambulatory settings, sleep histories are seldom documented and are addressed considerably less often than histories pertaining to alcohol use and cigarette smoking.
We evaluated the performance of house officers and medical students in addressing the following questions: How often is any sleep history documented in the medical records of patients hospitalized on an acute general medicine ward service? How does the frequency of documented sleep histories compare with that of other health promotion histories (cigarette smoking and alcohol use)? Does the frequency of documented sleep histories relate to the level of health professional education or discernible differences in patient demographic characteristics or approaches to patient evaluation?
Background. Sleep disorders are common, but the frequency of sleep history documentation in hospitalized patients is unknown.
Methods. We reviewed 442 initial histories and physical examinations recorded by 122 house officers and 47 medical students in 208 consecutive general medicine ward patients.
Results. Any reference to sleep was recorded in only 18 patients (9%), including 12 of 141 (9%) with conditions associated with obstructive sleep apnea. Sleep histories were recorded more often in women (13% vs 4%) and less often than histories of cigarette smoking or alcohol use. Medical students recorded such histories more often than did house officers. Patients with sleep histories more often had pulse oximetry (78% vs 37%), pulmonary function testing (11% vs 1%), arterial blood gas analysis (67% vs 30%), or electrocardiograms (78% vs 49%).
Conclusions. Sleep histories are documented infrequently in hospitalized patients. Patients with a recorded sleep history more often have tests that suggest increased concerns about cardiorespiratory risk and/or a different process of care.
Sleep disorders affect approximately 12% of the population and have been associated with reduced quality of life, motor vehicle accidents, and other catastrophes. Sleep-disordered breathing, such as obstructive sleep apnea (OSA), has been estimated to affect approximately 2% to 4% of adults and has been associated with hypertension, cardiovascular disorders, stroke, and mortality. Because approximately 80% to 90% of clinically significant OSA cases are not recognized, the recognition and treatment of sleep disorders should be a priority of health professionals. Sleep histories might help physicians and other health professionals to identify potentially treatable conditions, but the frequency with which the sleep history essential to diagnosis is done in an acute care setting is unknown. In ambulatory settings, sleep histories are seldom documented and are addressed considerably less often than histories pertaining to alcohol use and cigarette smoking.
We evaluated the performance of house officers and medical students in addressing the following questions: How often is any sleep history documented in the medical records of patients hospitalized on an acute general medicine ward service? How does the frequency of documented sleep histories compare with that of other health promotion histories (cigarette smoking and alcohol use)? Does the frequency of documented sleep histories relate to the level of health professional education or discernible differences in patient demographic characteristics or approaches to patient evaluation?
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