Background Patients attending primary care with possible Obstructive Sleep Apnoea (OSA) often describe difficulty getting off to sleep or maintaining sleep. This can be mistaken for insomnia by the referring doctor leading to some referrals being rejected, especially if no other information is available. In our service a clinical decision support system (CDSS) has been implemented which allows gathering of more detailed descriptive data and sleep history including insomnia symptoms. We investigated the frequency of initiation and maintenance insomnia in patients attending Liverpool Sleep and ventilation service.
Methods All patients attending Liverpool Sleep and Ventilation service from March- June 2021 were taken through the CDSS, with patients’ detailed history, demographics, diagnosis, investigation and treatment documented. All patients answer time to get to sleep, whether they experience difficulty falling asleep, disturbed sleep or nocturia. Output from the database was imported into excel for statistical analysis. Only patients with valid sleep study results were included.
Results A total of 325 patients were reviewed through the CDSS. 282 had a completed sleep study of which 250 had a confirmed diagnosis of OSA, mild, moderate, severe or no evidence of OSA and the remaining 32 had a possible diagnosis of OSA requiring further review. Of the confirmed diagnosis there were a higher proportion of males in the OSA group compared with not OSA along with higher AHI and ODI. The BMI were similar between the two groups and there was no difference in the ESS. We then compared the symptoms of initiation and maintenance insomnia between the two groups. 75% of patients with confirmed diagnosis of OSA experienced insomnia symptoms. We found that there was no difference in symptoms of time to get to sleep, difficulty to get to sleep and difficulty to remain asleep between those with OSA and those with no evidence of OSA. (see table 1).
Conclusion This suggests there is a large proportion of patients presenting to our service with difficulty falling or staying asleep. There are a similar proportion of patients describing these initiation and maintenance insomnia symptoms in those diagnosed with OSA compared to those where OSA was excluded.
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