Sleep as a vital sign

When I was in medical school, the four vital signs were blood pressure, pulse, breathing rate, and temperature. Over the years, pain level has been added to the list of vital signs by some medical practices and hospitals. Here is an interesting article advocating for assessment of sleep during routine medical visits, much like the way vital signs are automatically assessed with each patient encounter.

The authors note how sleep disorders are under-diagnosed, and how sleep disorders can affect so many other areas of a person's health. Also, many non-sleep disorders affect how a patient sleeps. At the end of the article, the authors pose a question as to how to assess a patient's sleep during a routine visit. Unfortunately, there is no rapid objective measure of sleep quality that can be used during a routine visit, like how we measure blood pressure. So an assessment of sleep is subjective, like the assessment of pain. Many non-sleep physicians already ask questions such as "How are you sleeping?". Perhaps having a patient rate their sleep quality on a scale of 1 to 10, similar to how some clinicians assess pain levels? That would be an interesting research project to do.

Truck Drivers and Online Assessment of Obstructive Sleep Apnea

A study done in the June edition of the Journal of Clinical Sleep Medicine describes data from an online self-assessment of obstructive sleep apnea (OSA) done by truck drivers anonymously. Some estimates say that OSA occurs in 1 in 4 commercial drivers. I blogged about this in May.

This study was a web-based survey of the Berlin Questionnaire, a valid screening tool used to assess risk of OSA. The Berlin has three sections - sleepiness, snoring, and body-mass index (BMI) and high blood pressure (HTN). If the Berlin was positive (indicating elevated risk of OSA), the driver was provided a link to a local sleep center for further evaluation.

The results of the survey showed that ~56% of respondents were positive on the Berlin and that 78% were positive on the BMI / HTN section. Seventy percent were obese, defined as a BMI >30. Witnessed apneas were reported in 21% of responders and almost 21% admitted to falling asleep while driving!

The results stress the importance of testing and treating commercial drivers. How to identify those drivers at risk is still being debated. Hopefully we will have some guidelines from the Federal Motor Carrier Safety Administration at the end of this summer.