Evaluation of sleep disorders in the primary care setting: history taking compared to questionnaires

The objective of this study was to determine if primary care providers (PCPs) screen for sleep disorders during clinical evaluation of new patients, and to compare this to likely sleep diagnoses as assessed by validated questionnaires.

Adult patients evaluated as new patients in a primary care clinic at a tertiary care center were included in a prospective study. Following their appointment, patients completed the Cleveland Sleep Habits questionnaire (CSHQ), Berlin questionnaire, Epworth Sleepiness Scale (ESS), and STOP questionnaire. The encounters were subsequently reviewed for elements of a sleep history, sleep review of systems, and/or sleep workup.

101 patients participated in the study.

58 (52%) females, mean age 38 ± 12.9 years, body mass index (BMI) 29.5 ± 8.3 kg/m² (BMI > 30 kg/m² in 44%), 46% Caucasian, 38% African American, 11% Hispanic, and 5% other. House staff evaluated 57.4%; faculty evaluated the remainder. The ESS was > 10 in 28% of subjects. High risk for obstructive sleep apnea (OSA) risk was found in 33% (Berlin) and 34% (STOP) (24.8% by both). The CSHQ suggested possible diagnoses of insomnia in 30% and restless legs syndrome in 22%. In the clinic encounters, a limited sleep history was found in 24.8%, documentation of a sleep disorder in 8.9%, referral to sleep clinic in 2%, and referral to psychiatry clinic in 6.9%.

Symptoms suggestive of sleep disorders are common but are not routinely screened for in the primary care setting. Validated questionnaires can efficiently identify patients at risk for common sleep disorders in this setting.