1
|
Silva FSL, Furlanetto KC, Neves LMT, Cipriano GFB, Accioly MF, Viana-Júnior AB, Alves TB, Moraes WRA, Lima ACGB, Ribeiro KB, Sobreira-Neto MA, Leite CF. Translation, transcultural adaptation, and validation of the Brazilian Portuguese version of the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire. Sleep Breath 2022; 27:1195-1201. [DOI: 10.1007/s11325-022-02661-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/05/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
|
2
|
Pendharkar SR, Blades K, Kelly JE, Tsai WH, Lien DC, Clement F, Woiceshyn J, McBrien KA. Perspectives on primary care management of obstructive sleep apnea: a qualitative study of patients and health care providers. J Clin Sleep Med 2021; 17:89-98. [PMID: 32975193 DOI: 10.5664/jcsm.8814] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Difficulties in providing timely access to care have prompted interest in primary care delivery models for obstructive sleep apnea (OSA). Sustainable implementation of such models requires codesign with input from key stakeholders. The purpose of this study was to identify patient and provider perspectives on barriers and facilitators to optimal, patient-centered management of OSA in a primary care setting. METHODS This study was conducted in Alberta, Canada. Data from key stakeholders were collected through an online survey of primary care providers (n = 119), focus groups and interviews with patients living with OSA (n = 28), and workshops with primary care and sleep providers (n = 36). Quantitative survey data were reported using descriptive statistics, and qualitative data were analyzed using an inductive thematic approach. RESULTS Several barriers were identified, including poor specialist access, variable primary care providers knowledge of OSA, and lack of clarity about provider roles for OSA management. Barriers contributed to patients being poorly informed about OSA, leading them to separate OSA from their overall health and eroding trust in the system. Suggestions for improvement included integration of care providers in a comprehensive model of care, facilitated by improved system navigation and more effective use of technology. Themes were consistent across data collection methods and between stakeholder groups. CONCLUSIONS Although primary care delivery models may improve access to OSA management, stakeholders identified important challenges in the current system. Innovative models of care, developed with input from patients and providers, may mitigate barriers and support optimal primary care management of OSA.
Collapse
Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Blades
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenny E Kelly
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dale C Lien
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jaana Woiceshyn
- Haskayne School of Business, University of Calgary, Calgary, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
3
|
Seixas AA, Trinh-Shevrin C, Ravenell J, Ogedegbe G, Zizi F, Jean-Louis G. Culturally tailored, peer-based sleep health education and social support to increase obstructive sleep apnea assessment and treatment adherence among a community sample of blacks: study protocol for a randomized controlled trial. Trials 2018; 19:519. [PMID: 30249293 PMCID: PMC6154893 DOI: 10.1186/s13063-018-2835-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.
Collapse
Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, New York School of Medicine, New York, NY USA
- Department of Psychiatry, NYU Langone Health, New York, NY 10016 USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Joseph Ravenell
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Ferdinand Zizi
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Girardin Jean-Louis
- Department of Population Health, New York School of Medicine, New York, NY USA
| |
Collapse
|
4
|
Williams NJ, Nunes JV, Zizi F, Okuyemi K, Airhihenbuwa CO, Ogedegbe G, Jean-Louis G. Factors associated with referrals for obstructive sleep apnea evaluation among community physicians. J Clin Sleep Med 2015; 11:23-6. [PMID: 25325590 DOI: 10.5664/jcsm.4356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 07/21/2014] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES This study assessed knowledge and attitudes toward obstructive sleep apnea (OSA) among community physicians and explored factors that are associated with referrals for OSA evaluation. METHODS Medical students and residents collected data from a convenience sample of 105 physicians practicing at community-based clinics in a large metropolitan area. Average age was 48 ± 14 years; 68% were male, 70% black, 24% white, and 6% identified as "other." Physicians completed the Obstructive Sleep Apnea Knowledge and Attitudes questionnaire. RESULTS The average year in physician practice was 18 ± 19 years. Of the sample, 90% reported providing care to black patients. The overall OSA referral rate made by physicians was 75%. OSA knowledge and attitudes scores ranged from 5 to 18 (mean = 14 ± 2) and from 7 to 20 (mean = 13 ± 3), respectively. OSA knowledge was associated with white race/ ethnicity (rp = 0.26, p < 0.05), fewer years in practice (rp = -0.38, p < 0.01), patients inquiring about OSA (rp = 0.31, p < 0.01), and number of OSA referrals made for OSA evaluation (rp = 0.30, p < 0.01). Positive attitude toward OSA was associated with patients inquiring about OSA (rp = 0.20, p < 0.05). Adjusting for OSA knowledge and attitudes showed that physicians whose patients inquired about OSA were nearly 10 times as likely to make a referral for OSA evaluation (OR = 9.38, 95% CI: 2.32-38.01, p < 0.01). CONCLUSION Independent of physicians' knowledge and attitudes toward obstructive sleep apnea, the likelihood of making a referral for obstructive sleep apnea evaluation was influenced by whether patients inquired about the condition.
Collapse
Affiliation(s)
- Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
| | - João V Nunes
- Department of Physiology, Pharmacology and Neuroscience, The Sophie Davis School of Biomedical Education, The City College of New York, New York, NY
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
| | - Kola Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY
| |
Collapse
|
5
|
Sleep apnoea: no laughing matter. Br J Gen Pract 2011; 61:434-5. [PMID: 21722456 DOI: 10.3399/bjgp11x583001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
6
|
Demede M, Pandey A, Zizi F, Bachmann R, Donat M, McFarlane SI, Jean-Louis G, Ogedegbe G. Resistant hypertension and obstructive sleep apnea in the primary-care setting. Int J Hypertens 2011; 2011:340929. [PMID: 21755035 PMCID: PMC3132606 DOI: 10.4061/2011/340929] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/28/2011] [Indexed: 01/13/2023] Open
Abstract
We ascertained the prevalence of resistant hypertension (RH) among blacks and determined whether RH patients are at greater risk for obstructive sleep apnea (OSA) than hypertensives. Method. Data emanated from Metabolic Syndrome Outcome Study (MetSO), a study investigating metabolic syndrome among blacks in the primary-care setting. Sample of 200 patients (mean age = 63 ± 13 years; female = 61%) with a diagnosis of hypertension provided subjective and clinical data. RH was defined using the JNC 7and European Society guidelines. We assessed OSA risk using the Apnea Risk Evaluation System ARES), defining high risk as a total ARES score ≥6. Results. Overall, 26% met criteria for RH and 40% were at high OSA risk. Logistic regression analysis, adjusting for effects of age, gender, and medical co morbidities, showed that patients with RH were nearly 2.5 times more likely to be at high OSA risk, relative to those with hypertension (OR = 2.46, 95% CI: 1.03-5.88, P < .05). Conclusion. Our findings show that the prevalence of RH among blacks fell within the range of RH for the general hypertensive population (3-29%). However, patients with RH were at significantly greater risk of OSA compared to patients with hypertension.
Collapse
Affiliation(s)
- M. Demede
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - A. Pandey
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - F. Zizi
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
- Sleep Disorders Center, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - R. Bachmann
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - M. Donat
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
- Department of Family Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - S. I. McFarlane
- Department of Endocrinology, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - G. Jean-Louis
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
- Sleep Disorders Center, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - G. Ogedegbe
- Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, NY 10016, USA
| |
Collapse
|
7
|
Shapiro GK, Shapiro CM. Factors that influence CPAP adherence: an overview. Sleep Breath 2010; 14:323-35. [PMID: 20661654 DOI: 10.1007/s11325-010-0391-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 07/01/2010] [Accepted: 07/10/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea syndrome (OSAS). Consistent adherence to CPAP improves the patient's longevity and quality of life as well as public safety. However, nonadherence is a significant contributor to the growing burden of untreated OSAS, and is associated with negative consequences for the patient, public safety, and the healthcare system. OBJECTIVE The use of CPAP is a classic example of an effective treatment for which adherence is extremely variable. This paper examines a multiplicity of factors that influence CPAP adherence. FACTORS These factors are traditionally thought of in terms of patient and equipment variables, but in addition physician, family, healthcare facility, and governmental issues all contribute to CPAP adherence. DISCUSSION These factors are reviewed and pragmatic recommendations are made for improving clinical practice.
Collapse
Affiliation(s)
- Gilla K Shapiro
- Youthdale Child and Adolescent Sleep, 227 Victoria St., Lower Level 2, Toronto, ON, M5B 1T8, Canada.
| | | |
Collapse
|
8
|
Zizi F, Jean-Louis G, Fernandez S, von Gizycki H, Lazar JM, Nunes J, Brown CD. Symptoms of obstructive sleep apnea in a Caribbean sample. Sleep Breath 2008; 12:317-22. [PMID: 18516637 DOI: 10.1007/s11325-008-0190-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 02/20/2008] [Accepted: 03/22/2008] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep disorder that disproportionately affects blacks. While clinical and epidemiologic data indicate intraethnic differences in several medical diseases, little is known about whether OSA symptoms differ within the black ethnic group. We estimated the rate of OSA symptoms in a community-based sample of Caribbean-born black men and women. We also ascertained which sociodemographic and/or medical factors were associated with OSA risk. A total of 554 patients (mean age = 48.17 +/- 16.75 years) participated in the study; 55% were women. Data were collected in four primary-care clinics in Brooklyn, NY. A health educator explained the purpose of the study to interested patients and assisted consenting participants in completing questionnaires, which required 15 min to complete. Participants reporting habitual snoring, excessive daytime sleepiness, and sleep fragmentation were considered at high OSA risk. The rate of OSA symptoms was: snoring (45%), excessive daytime sleepiness (33%), and difficulty maintaining sleep (34%). Many reported falling asleep while watching television (47%) or while driving (14%). Based on logistic regression analysis, a history of heart disease was the most important predictor of the likelihood of expressing OSA symptoms, with a corresponding multivariate-adjusted odds ratio of 11 (95% confidence interval = 3.03-40.63). Findings suggest the need to investigate whether Caribbean-born blacks are at greater risk for developing OSA than African Americans and whites. Caribbean-born blacks with a history of heart disease should be a prime target for interventions that promote adequate screening and timely OSA diagnosis.
Collapse
Affiliation(s)
- Ferdinand Zizi
- Brooklyn Center for Health Disparities, Division of Cardiovascular Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Bian H, Smith CL. Development of a questionnaire to assess dentists' knowledge, opinion, education resources, physician cooperation, and clinical practice regarding obstructive sleep apnea (OSAQ-D). Sleep Breath 2007; 10:76-82. [PMID: 16528577 DOI: 10.1007/s11325-005-0045-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes the construction of a questionnaire to assess dentists' knowledge, opinion, education resources, clinical practice, and physician cooperation regarding obstructive sleep apnea (OSA) based on the PRECEDE-PROCEED model. The scale development included such steps as generating an item pool, expert review of initial item pool, pilot test, and final test. After the expert review, a total of 78 items made up the pilot test instrument including five demographic (age, year graduated from dental school, gender, years in practice dentistry, and membership of the Academy of Dental Sleep Medicine), 22 knowledge, 15 opinion, 11 education resources, 10 physician cooperation, and 15 clinical practice questions. The pilot test samples were third or fourth year dental school students and dentists from the University of Florida. Nineteen dentists and 26 students returned the survey. Based on the results of item analysis and content review, a total of 70 questions were remained for the final test. The final questionnaire was mailed to 450 dentists who were randomly selected from a list of 10,838 dentists with a Florida license and also delivered to 65 dental school students and postgraduates of the University of Florida. A total of 163 participants including 112 dentists and 51 students and postgraduates responded. The average age was 42.87 years, and most of them are males (77.8%). Only one dentist was a current member of the Academy of Dental Sleep Medicine. The item analysis was performed for five scales. 8 items with poor item difficulty, lower item discrimination, or having big effect on the item consistency were removed from the instrument, and 62 questions were kept for the further evaluation. The reliability coefficient alpha of knowledge, opinion, education resources, physician cooperation, and clinical practice scales was 0.77, 0.86, 0.67, 0.75, and 0.86, respectively. According to the standard from DeVellis (Scale development: theory and applications, Sage, Thousand Oaks, 2003), they were acceptable, or respectable, or even very good.
Collapse
Affiliation(s)
- Hui Bian
- Department of Health Education and Behavior, University of Florida, P.O. Box 118210,, Gainesville, FL, 32611-8210, USA.
| | | |
Collapse
|
10
|
Scharf SM, DeMore J, Landau T, Smale P. Comparison of primary-care practitioners and sleep specialists in the treatment of obstructive sleep apnea. Sleep Breath 2005; 8:111-24. [PMID: 15389385 DOI: 10.1007/s11325-004-0111-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We wished to determine if being treated for sleep apnea by a sleep specialist increased patient awareness or long-term continuous positive airway pressure (CPAP) compliance. We performed a retrospective telephone survey and laboratory chart review in patients with a diagnosis of sleep apnea evaluated either at a laboratory in which only sleep specialists can order polysomnography (University Specialty Hospital, noted as USH) or at a laboratory serving the medical community at large (Kernan Hospital, noted as K). Both laboratories are under the same medical director, use the same policies and procedures, equipment, and technician pool. One hundred three patients participated in the survey (approximately 37% of those contacted), 59 from USH and 44 from K. The groups were comparable in terms of demographics, presenting complaints, and apnea severity. In patients treated by sleep specialists, awareness of the disease process was greater and the evaluation was timelier than in patients treated by generalists. However, there was no difference between the groups' long-term self-reported CPAP acceptance or compliance. The most robust predictor of continued CPAP use was the patient's self-report of feeling better.
Collapse
Affiliation(s)
- Steven M Scharf
- Sleep Disorders Center, Division of Pulmonary and Critical Care, University of Maryland, Baltimore, Maryland 21209, USA.
| | | | | | | |
Collapse
|