A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial

PLoS One. 2014 Jun 30;9(6):e101003. doi: 10.1371/journal.pone.0101003. eCollection 2014.

Abstract

Background: Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the number of participants identified in RAO or RA+ group who were likely to have and consequently be diagnosed with OSA. Further outcomes included the number of participants identified as being at risk for, referred for, taking-up referral for, and then diagnosed with OSA, insomnia, and/or restless legs syndrome (RLS) in either group.

Methods: In a cluster-randomized trial, participants were recruited through 23 community pharmacies. Using validated instruments, 325 (RAO = 152, RA+ = 173) participants were screened for OSA, insomnia, and RLS.

Findings: 218 (67%) participants were at risk of OSA, insomnia or RLS and these participants were referred to their primary physician. The proportion of screened participants identified as being at risk of OSA was significantly higher in the RA+ group (36% in RAO vs. 66% in RA+, OR 3.4, 95% CI (1.8-6.5), p<0.001). A 12-month follow-up was completed in 125 RAO and 155 RA+ participants. Actual referral uptake was 34% RAO, 26% RA+, OR 4.4, 95% CI (1.4-19.2), p = 0.31. The OSA diagnosis rate was higher in the RA+ arm (p = 0.01). To yield a single additional confirmed OSA diagnosis, 16 people would need to be screened using the RA+ protocol.

Conclusions: These results demonstrate that utilising either screening method is feasible in identifying individuals in the community pharmacy setting who are likely to have OSA, insomnia and/or RLS. Secondly, adding an objective marker of OSA to a questionnaire-based prediction tool resulted in more confirmed OSA diagnoses.

Trial registration: ACTR.org.au ACTRN12608000628347.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Demography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Pharmacies*
  • Polysomnography
  • Referral and Consultation
  • Risk Factors
  • Sleep Wake Disorders / diagnosis*

Associated data

  • ANZCTR/ACTRN12608000628347

Grant support

This study was performed at the Faculty of Pharmacy, The University of Sydney, NSW, Australia, with the financial support of the Australian Government Department of Health and Ageing through The Pharmacy Guild of Australia's Fourth Community Pharmacy Agreement Research & Development scheme. The funded study was undertaken by independent researchers and, therefore, the views, hypotheses and subsequent findings of the research are not necessarily those of the Pharmacy Guild of Australia. Prof. Grunstein is a recipient of the NHMRC Practitioner Fellowship. Dr. Wong, Dr. Saini and Prof. Grunstein are investigators of CIRUS, the NHMRC Centre for Interdisciplinary Sleep Health (funding through NHMRC Grants 264598 and 571241). Ms. Fuller is a PhD Scholar supported through the Faculty of Pharmacy and CIRUS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.