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A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial.

Publication ,  Journal Article
Edinger, JD; Grubber, J; Ulmer, C; Zervakis, J; Olsen, M
Published in: Sleep
January 1, 2016

OBJECTIVES: To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management. METHODS: This study used a randomized, parallel group, clinical intervention trial design. A total of 137 adult (29 women) VA outpatients with sleep complaints were enrolled and randomly assigned to (1) an intervention (INT) consisting of a one-time consultation with a sleep specialist who provided diagnostic feedback and treatment recommendations to the patient and the patient's primary care provider; or (2) a control condition consisting of their usual primary care (UPC). Provider-focused outcomes included rates of adherence to recommended diagnostic procedures and sleep-focused interventions. Patient-focused outcomes included measures taken from sleep diaries and actigraphy; Pittsburgh Sleep Quality Index (PSQI) scores; and self-report measures of sleepiness, fatigue, mood, quality of life, and satisfaction with health care. RESULTS: The proportions of provider-initiated sleep-focused interventions were significantly higher in the INT group than in the UPC group for polysomnography referrals (49% versus 6%; P < 0.001) and mental health clinic referrals (19% versus 6%; P = 0.02). At the 10-mo follow up, INT recipients showed greater estimated mean reductions in diary total wake time (-17.0 min; 95% confidence interval [CI]: -30.9, -3.1; P = 0.02) and greater increases in sleep efficiency (+3.7%; 95% CI: 0.8, 6.5; P = 0.01) than did UPC participants. A greater proportion of the INT group showed ≥ 1 standard deviation decline on the PSQI from baseline to the 10-mo follow-up (41% versus 21%; P = 0.02). Moreover, 69% of the INT group had normal (≤ 10) Epworth Sleepiness Scale scores at the 10-mo follow-up, whereas only 50% of the UPC group fell below this clinical cutoff (P = 0.03). CONCLUSIONS: A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and resulted in benefits to patients' sleep/wake symptoms. CLINICAL TRIALS REGISTRATION: This study is registered with clinicaltrials.gov with identifier # NCT00390572.

Duke Scholars

Published In

Sleep

DOI

EISSN

1550-9109

Publication Date

January 1, 2016

Volume

39

Issue

1

Start / End Page

237 / 247

Location

United States

Related Subject Headings

  • Wakefulness
  • Sleep Wake Disorders
  • Sleep Stages
  • Sleep Medicine Specialty
  • Self Report
  • Referral and Consultation
  • Quality of Life
  • Primary Health Care
  • Polysomnography
  • Neurology & Neurosurgery
 

Citation

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Edinger, J. D., Grubber, J., Ulmer, C., Zervakis, J., & Olsen, M. (2016). A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial. Sleep, 39(1), 237–247. https://doi.org/10.5665/sleep.5356
Edinger, Jack D., Janet Grubber, Christi Ulmer, Jennifer Zervakis, and Maren Olsen. “A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial.Sleep 39, no. 1 (January 1, 2016): 237–47. https://doi.org/10.5665/sleep.5356.
Edinger JD, Grubber J, Ulmer C, Zervakis J, Olsen M. A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial. Sleep. 2016 Jan 1;39(1):237–47.
Edinger, Jack D., et al. “A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial.Sleep, vol. 39, no. 1, Jan. 2016, pp. 237–47. Pubmed, doi:10.5665/sleep.5356.
Edinger JD, Grubber J, Ulmer C, Zervakis J, Olsen M. A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial. Sleep. 2016 Jan 1;39(1):237–247.
Journal cover image

Published In

Sleep

DOI

EISSN

1550-9109

Publication Date

January 1, 2016

Volume

39

Issue

1

Start / End Page

237 / 247

Location

United States

Related Subject Headings

  • Wakefulness
  • Sleep Wake Disorders
  • Sleep Stages
  • Sleep Medicine Specialty
  • Self Report
  • Referral and Consultation
  • Quality of Life
  • Primary Health Care
  • Polysomnography
  • Neurology & Neurosurgery