Abstract
Objective To develop, pilot and determine the feasibility of a sleep-specific screening and awareness program in community pharmacies. Setting The screening was piloted in five Australian community pharmacies. Method The Pharmacy Tool for Assessment of Sleep Health was constructed by drawing on known relationships between sleep disorders, and lifestyle factors, medical conditions and medications. Four validated instruments were used in the screening tool: the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Multivariable Apnea Prediction Index (MAPI) and International Restless Legs Syndrome Study Group Screening Criteria (IRLS). These instruments were used to predict the participant’s risk of a sleep disorder and the results were compared with reported lifestyle, medical and medication factors. On-site training of consenting pharmacists was provided, followed by an eight week client recruiting and screening period. Feedback was elicited from participating pharmacists and clients. Main outcome measure The feasibility of, and trends found from, the developed screening tool and protocol. Results Of 167 clients who requested or were invited to participate by pharmacists, 84 (50.3%) were screened. Analysis of collected data indicated that 33.3%, 21.4% and 27.4% of participants were at risk of having or developing insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS) respectively, while 38.1% were not at risk of any of the screened disorders. OSA odds increased 12.8 times (95% CI: 3.2–50.4) with diabetes and 4.9 times (1.2–20.9) with opioid use, while shift workers were 8.4 times (1.6–43.2) more likely to have insomnia. Participants and pharmacists reported the screening protocol and instrument was user friendly and feasible. Conclusion The development and pilot of this screening tool was successful. The prevalence of sleep disorders in the sampled population was high but generally consistent with previous studies on the general population. Furthermore, associations found may form a foundation for a clinical algorithm to identify those at a higher risk of having or developing a sleep disorder. Further work is required to validate this screening tool in the community pharmacy context.
Similar content being viewed by others
Abbreviations
- ESS:
-
Epworth Sleepiness Scale
- ISI:
-
Insomnia Severity Index
- MAPI:
-
Multivariable Apnea Prediction Index
- IRLS:
-
International Restless Legs Syndrome Study Group Screening Criteria
- OSA:
-
Obstructive sleep apnea
- RLS:
-
Restless legs syndrome
- EDS:
-
Excessive daytime sleepiness
- QoL:
-
Quality of life
- PSG:
-
Polysomnography
- BMI:
-
Body mass index
References
Anonymous. Wake up Australia: the value of healthy sleep: access economics; 2004. http://www.accesseconomics.com.au/publicationsreports. Accessed 4 Aug 2008.
Colagiuri S, Colagiuri R, Conway B, Grainger D, Davey P. DiabCo$t Australia: Assessing the burden of Type 2 Diabetes in Australia. 2003. Diabetes Australia; Canberra. ISBN 1 875690 20 4.
Britt H, Miller GC, Charles J, Bayram C, Pan Y, Henderson J et al. General practice activity in Australia 2006–07, in General Practice Series. 2008, Australian Institute of Health and Welfare: Canberra. http://www.aihw.gov.au/ Accessed 4 August 2008.
Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39:411–8. doi:10.1016/0006-3223(95)00188-3.
Engleman HM, Douglas NJ. Sleep 4: sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax. 2004;59:618–22. doi:10.1136/thx.2003.015867.
McNicholas WT, Bonsigore MR. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J. 2007;29:156–78. doi:10.1183/09031936.00027406.
Peppard PE, Young T, Palta M, Skatrud J. Prospective study on the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84. doi:10.1056/NEJM200005113421901.
Hening W, Walters AS, Allen RP, Montplaisir J, Myers A, Ferini-Strambi L. Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study. Sleep Med. 2004;5:237–46. doi:10.1016/j.sleep.2004.03.006.
Winkelman JW, Finn L, Young T. Prevalence and correlates of restless legs syndrome symptoms in the Wisconsin Sleep Cohort. Sleep Med. 2006;7:545–52. doi:10.1016/j.sleep.2006.01.004.
Winkelman JW, Shahar E, Sharief I, Gottlieb DJ. Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology. 2008;70:35–42. doi:10.1212/01.wnl.0000287072.93277.c9.
Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–6.
Marshall NS, Wilsmore BR, McEvoy RD, Wheatley JR, Dodd MJ, Grunstein RR. Polysomnography in Australia—trends in provision. J Clin Sleep Med. 2007;3:281–4.
Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatle J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169:668–72. doi:10.1164/rccm.200308-1124PP.
Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care. 2007;16:303–7. doi:10.1136/qshc.2006.020883.
Hersberger KE, Renggli VP, Nirkko AC, Mathis J, Schwegler K, Bloch KE. Screening for sleep disorders in community pharmacies—evaluation of a campaign in Switzerland. J Clin Pharm Ther. 2006;31:35–41. doi:10.1111/j.1365-2710.2006.00698.x.
Krass I, Mitchell B, Clarke P, Brillant M, Dienaar R, Hughes J, et al. Pharmacy diabetes care program: analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy. Diabetes Res Clin Pract. 2007;75:339–47. doi:10.1016/j.diabres.2006.06.022.
Mangum SA, Kraenow KR, Narducci WA. Identifying at-risk patients through community pharmacy-based hypertension and stroke prevention screening projects. J Am Pharm Assoc. 2003;43:50–5. doi:10.1331/10865800360467042.
Black J, Saini B, Wong K. The role of pharmacists in improving the management of sleep disorders in the Australian Community. Respirology. 2007;12:A24.
Johns MW. A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep. 1991;14:540–5.
Maslin G, Pack AI, Kribbs NB, Smith Pl, Schwartz AR, Kline LR, et al. A survey screen for prediction of apnea. Sleep. 1995;18:158–66.
Morin CM. Insomnia: psychological assessment and management. New York: The Guilford Press; 1993. ISBN 1572301201.
Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003;4:121–32. doi:10.1016/S1389-9457(02)00258-7.
Jefferson CD, Drake CL, Scofield HM, Myers E, McClure T, Roehrs T, et al. Sleep hygiene practices in a population-based sample of insomniacs. Sleep. 2005;28:611–5.
Ohayon MM, Lemoine P, Arnaud-Briant V, Dreyfus M. Prevalence and consequences of sleep disorders in a shift worker population. J Psychosom Res. 2002;53:577–83. doi:10.1016/S0022-3999(02)00438-5.
Wetter DW, Young TB. The relation between cigarette smoking and sleep disturbances. Prev Med. 1994;23:328–34. doi:10.1006/pmed.1994.1046.
Schweitzer PK. Drugs that disturb sleep and wakefulness. In: Kryger M, Roth T, Dement W, editors. Principles and practice of sleep medicine. 4th ed. Philadelphia: Elsevier Saunders; 2005. ISBN 9780721607979.
Bartlett DJ, Marshall NS, Williams A, Grunstein RR. Sleep health New South Wales: chronic sleep restriction and daytime sleepiness. Intern Med J. 2008;38:24–31.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5. doi:10.1056/NEJM199304293281704.
Högl B, Kiechl S, Willeit J, Saletu M, Frauscher B. Seppi restless legs syndrome: a community-based study of prevalence, severity, and risk factors. Neurology. 2005;64:1920–4. doi:10.1212/01.WNL.0000163996.64461.A3.
Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med. 2007;3:33–6.
Wang D, Teichtahl H. Opioids, sleep architecture and sleep-disordered breathing. Sleep Med Rev. 2007;11:35–46. doi:10.1016/j.smrv.2006.03.006.
Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes. Am J Respir Crit Care Med. 2005;172:1590–5. doi:10.1164/rccm.200504-637OC.
Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013–6. doi:10.1001/jama.291.16.2013.
Australian Institute of Health and Welfare. Australia’s health 2008. Canberra: AIHW; 2008. http://www.aihw.gov.au/publications/index.cfm/title/10585 Accessed 20 Nov 2008.
Yee B, Campbell A, Beasley R, Neill A. Sleep disorders: a potential role in New Zealand motor vehicle accidents. Intern Med J. 2002;32:297–304. doi:10.1046/j.1445-5994.2002.00229.x.
Rosenthal LD, Dolan D. The Epworth Sleepiness Scale in the identification of obstructive sleep apnea. J Nerv Ment Dis. 2008;196(5):429–31.
Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307.
Savard M, Savard J, Simard S, Ivers H. Empirical validation of the Insomnia Severity Index in cancer patients. Psychooncology. 2005;14(6):429–41.
Gurubhagavatula I, Maislin G, Nkwuo JE, Pack AI. Occupational screening for obstructive sleep apnea in commercial drivers. Am J Respir Crit Care Med. 2004;170(4):371–6.
Abetz L, Arbuckle R, Allen R, Garcia-Borreguero D, Hening W, Walters A, et al. The reliability, validity and responsiveness of the International Restless Legs Syndrome Study Group rating scale and subscales in a clinical-trial setting. Sleep Med. 2006;7(4):340–9.
Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless Legs Syndrome prevalence and impact: REST General Population Study. Arch Intern Med. 2005;165(11):1286–92.
Acknowledgements
We would like to thank all participants and pharmacists involved in the study.
Funding
This study was funded under the Fourth Community Pharmacy Agreement Research & Development Program (Investigator Initiated Grant, Identification number: Q0052R1931), The Pharmacy Guild of Australia.
Conflict of interest statement
There was no conflict of interest influencing the publication of this pilot study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tran, A., Fuller, J.M., Wong, K.K. et al. The development of a sleep disorder screening program in Australian community pharmacies. Pharm World Sci 31, 473–480 (2009). https://doi.org/10.1007/s11096-009-9301-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-009-9301-4