Original articleA new questionnaire to detect sleep disorders☆
Introduction
Sleep disorders have an estimated prevalence of 15–27% in the adult population [1], [2]. According to the National Commission on Sleep Disorders Research, approximately 70 million Americans suffer from sleep-related problems. Of those, 40 million have chronic sleep disorders [1]. Obstructive sleep apnea (OSA) and disorders associated with insomnia account for the majority of sleep disorders, occurring in as many as 9% of women, 24% of men [3], and 30–36% of the population, respectively [4].
In addition to their high prevalence rates, sleep problems are associated with health problems, functioning and well-being, work-related indicators and health care expenditures [5], [6]. A number of recent studies have demonstrated that individuals with current sleep problems report significantly poorer health, less energy and worse cognitive functioning than those categorized as having no sleep problem [5], [7]. In another study, individuals with insomnia resulting in daytime dysfunction reported significantly lower quality-of-life scores on each of the individual eight domains and summary scores of the Short Form-36 (SF-36), as well as greater resource utilization due to more frequent ER visits, physician visits and use of prescription and/or over-the-counter drugs [6].
Despite these consequences, sleep disorders are not widely detected or treated [5]. Possible reasons for this finding may be the lack of training in the recognition of sleep disorders, the uncertainty of how to treat and/or refer patients with this condition, or because of the failure of patients and/or providers to discuss sleep problems during a health care visit.
Currently, a limited number of screening tools are available to detect some sleep disorders in adults [8], [9], [10], [11], [12], [13], [14]. The Berlin questionnaire [8], which was designed to identify patients as being at ‘high’ or ‘low’ risk for OSA, assesses the patient's risk level based on approximately 11 questions addressing three symptom categories: snoring, sleepiness, and high blood pressure/weight. The Sleep Disorders Questionnaire (SDQ) [9] was developed to diagnose four categories of sleep disorders: OSA, narcolepsy, psychiatric sleep disorder, and periodic limb movement (PLM) disorder. Due to its length (176 items), the researchers concluded that the SDQ is not a practical instrument for use in screening the general population for common sleep disorders. The Pittsburgh Sleep Quality Index (PSQI) was developed to assist in measuring sleep quality, and, in turn, to alert physicians of the need to further evaluate their patients. This 24-item questionnaire is most appropriate for either measuring changes in sleep quality over time in patients, or in measuring differences in sleep quality between diseased groups, but does not aid in the diagnosis of a particular sleep disorder [10].
As such, no comprehensive screening questionnaire could be identified that was practical for use in primary care, and had undergone rigorous testing of its psychometric properties. Therefore, a screening tool for the most prevalent sleep disorders in adults — the Global Sleep Assessment Questionnaire (GSAQ) — was developed. The primary objectives of this study were to implement the GSAQ in primary care and sleep centers with the following aims: (1), to develop optimal criteria for identifying each target sleep disorder with the GSAQ; (2), to evaluate the psychometric properties (content validity, test–retest reliability, construct validity, sensitivity/specificity) of the GSAQ for each of these disorders; and (3), to evaluate the potential utility of the GSAQ as a screening tool for sleep disorders in primary care and sleep specialty centers.
Section snippets
Overview
Eligible and interested patients who presented to either a sleep center or a primary care clinic with no previous diagnosis of a sleep disorder were enrolled in this multi-center study. All participants completed the GSAQ at least once and underwent a clinical evaluation by a board-certified sleep specialist.
The GSAQ is a self-administered screening tool which was designed for use by clinicians to aid in the diagnosis of sleep-related disorders. The questionnaire used in the current study
Results
A total of 212 patients with a confirmed sleep diagnosis completed the study: 168 sleep center patients representing five sleep clinics and 44 primary care patients from two primary care clinics. Table 1 displays the demographic characteristics of the overall study group, as well as separately reporting those of patients from the sleep and primary care centers. Overall, the majority of respondents were female and Caucasian, had at least some college education, reported an income of $49,999 or
Discussion
Optimally, the GSAQ could be used to screen for sleep disorders in a general primary care population. In addition, it may be useful to administer the GSAQ on a regular basis to ensure that no sleep disorder has developed. The specific scoring guide for the GSAQ evaluates each diagnosis separately, and sums item responses to designate whether a patient merits additional investigation into sleep disorders.
The clinical utility of a sleep screening tool depends on predictive values likely to be
Acknowledgements
The authors would like to thank Elisabeth Warren, whose help in all aspects of the study has been invaluable, and Dave Miller and Michelle Pritchard for their statistical expertise. Recruitment would not have been possible without the contributions of Syed Akbarullah M.D., Laurie DeSimone, Minisha Kochar, Gail Koshorek, John Pinto M.D., Kathleen Rice Ph.D., Sharon Schutte M.D., Candida Sherrill, and Darlene Steljes at our study sites.
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This study was supported by Pharmacia Corporation.