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Physicians
who attended medical schools a decade ago probably don’t remember being
taught one snore of sleep medicine.
Today,
sleep has a slightly larger part in many schools’ curriculum. Yet, many
health care professionals still don’t know key aspects of this
field.
Gaining Some Ground
In 1992, the National Commission on Sleep Disorders Research conducted
a study that looked at sleep education in 125 medical schools, explained
Rochelle Zozula, PhD, clinical director of the Comprehensive Sleep
Disorders Center at Robert Wood Johnson University Hospital, New
Brunswick, N.J.
The investigators found in the first two years of school (pre-clinical),
students spent only a little more than an hour on sleep topics. For the
last two years (clinical), it dipped down to .9 hour. “This is a blip on
the radar screen,” Dr. Zozula said.
Eight
years later, the American Academy of Sleep Medicine (then the American
Sleep Disorders Association) assembled another task force to assess the
current status of sleep education in medical schools. The group found
mild improvement. Pre-clinical went up to 2.1 hours, and clinical rose to
4.8 hours.
Beefing up
sleep education even more needs to be a priority, Dr. Zozula said,
because large-scale epidemiological studies show that up to 70 percent of
primary care patients or those seeking specialist attention have
sleep-related complaints.
“The issue
is lack of training and available resources,” she said. “Many medical
professionals receive minimal, minimal training in sleep and sleep
disorders.”
The
training deficiency in the classroom may translate to missed
opportunities when seeing patients. A study presented at the 2002 meeting
of the Associated Professional Sleep Societies found that only 48 percent
of attending physicians, residents and medical students at the University
of Missouri, Columbia, routinely obtained a sleep history from their
patients, and 39.2 percent gave referrals for sleep studies.1
Looking
in the Wrong Places
Dr.
Zozula, who has conducted several studies examining sleep awareness among
health professionals, said one of the barriers to care is system-based in
terms of resources available and time restraints during a consultation.
“If a
patient comes to you with a primary complaint where they have high blood
pressure or diabetes, the doctors are going to focus on the treatment of
those primary medical disorders,” she said. “We feel equally important is
sleep, and without adequate sleep, that puts the patient at higher risk
for the development of sleep problems that promote hypertension or might
actually lead to the inability to effectively treat underlying medical
disorders.”
Oftentimes,
general practitioners will look to run blood work instead doing a sleep
history, agreed David Ostransky, DO, medical director of the sleep lab at
Osteopathic Medical Center of Texas, Fort Worth, and the Harris Methodist
Erath County Sleep Laboratory, Stephenville, Texas.
However, some primary care doctors are more aware of the impact of sleep
disorders and that they cause significant daytime consequences, he said.
“These sleep disorder savvy primary care physicians will request sleep
medicine consultations and sleep studies more often.”
The University of Missouri study, which also showed 74.1 percent of
physicians received no training at all in sleep medicine, found that 95
percent said snoring, excessive daytime sleepiness and obesity were the
most frequent features to raise the index of suspicion for sleep apnea.1 However, 58.6
percent didn’t know that erectile dysfunction may be associated with the
disease.
A
tremendous focus on the impact of sleep disorders by groups such as the
National Institutes of Health and the National Sleep Foundation makes Dr.
Ostransky feel optimistic about physicians becoming more aware of sleep
disorders. “For instance, many articles are written monthly on the link
between obstructive sleep apnea and heart disease and hypertension,” he
said. “We have seen a marked increase in sleep study referrals from
cardiologists in the last two years.”
Unfortunately,
other important sleep disorders and interrelationships may not be getting
the attention they deserve, Dr. Zozula said. There needs to be a greater
understanding about narcolepsy as well as the connection between mood or
anxiety disorders and sleep complaints. Also, primary care practitioners
should become better versed in restless legs syndrome and periodic limb
movement disorder and its commonality with pregnancy, iron deficiency and
end-stage renal disease.
“They are learning,” she said. “But if their medical school training was
10, 15 or more than 20 years ago, they may be falling behind the curve.”
Reference
1.
Sahota PK, Dabbagh O, Jain SS, Sivaraman M, Martin A, Shawa I. Sleep
awareness among health care professionals. Sleep. 2002;25:A515.
Mike Bederka is assistant editor of ADVANCE.
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