P071 Listening to Beyoncé: factors associated with non-attendance at an outpatient sleep clinic

Introduction Patient non-attendance at outpatient sleep clinics is common and costly. Little is known about the factors associated with sleep clinic non-attendance, especially in an Australian context. The goal of our audit was to identify the patient, referral, and appointment factors that may affect attendance at an outpatient sleep clinic. Methods A case-control study was performed in 171 patients (57 cases / non-attenders and 114 controls / attenders) who had a sleep clinic appointment between September 20th, 2020 and March 21st, 2021. Statistical analysis was performed using the two-sided chi-square test with a 5% significance level. Results The overall rate of non-attendance was 10.8%. The rates of non-attendance between new and review cases were similar. Being single (odds ratio [OR]: 2.49; p = 0.010), middle-aged (OR: 4.39; p < 0.001 vs. older-aged), or female (OR: 2.08; p = 0.026) was associated with a higher rate of non-attendance. English was the primary language for all non-attenders. A higher proportion of non-attenders than attenders were born in Australia. For new cases, the source of referral, reason for referral, and triage category did not affect attendance rates. Likewise, the patient’s primary sleep disorder and treatment status did not affect attendance for review cases. Conclusion Factors associated with non-attendance at an outpatient sleep clinic include being single, middle-aged, or female. By identifying patients at higher risk of clinic non-attendance, a more tailored approach can be developed to mitigate this issue.

Pediatric Sleep–Wake Disorders

This chapter reviews pediatric sleep–wake disorders, with a particular focus on evaluation and treatment of sleep disturbances comorbid with primary psychiatric disorders and commonly prevalent primary sleep disorders in the pediatric population. The sleep disturbances due to primary sleep disorders can often result in symptoms and behaviors suggestive of a psychiatric condition such as inattention, poor impulse control, academic impairment, mood changes, fatigue, and excessive daytime sleepiness. It is important that the pediatric clinician assesses the youth presenting with sleep and psychiatric symptomatology for presence of primary sleep disorders. Consultation with a sleep physician for further evaluation and treatment is recommended if a primary sleep disorder is suspected. More evidence-based treatments are needed for primary insomnia and sleep disturbances comorbid with primary psychiatric disorders in pediatric population.

Clinical Applications of Technical Procedures in Sleep Medicine

This chapter discusses diagnostic procedures used in the evaluation and management of sleep disorders commonly encountered in psychiatric patients. Primary sleep disorders including insomnia, breathing-related sleep disorder, sleep-related movement disorders, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders and parasomnias are frequently comorbid with psychiatric disorders. A comprehensive sleep history and physical exam with special attention to respiratory, cardiovascular, and neurologic systems are essential to determine appropriate diagnostic procedure(s) needed to uncover coexisting primary sleep disorder(s) in psychiatric patients. These diagnostic procedures include polysomnography, home sleep apnea testing, multiple sleep latency test, maintenance of wakefulness test, and actigraphy. This chapter focuses on the clinical indications and appropriate patient selection for application of these diagnostic sleep procedures in psychiatric patients.

Fatigue

A systematic approach to fatigue: Figure out how bad it is; rule out the complaint of concussion-related fatigue as an excuse to get out of school, work, or unpleasant chores at home by asking the collateral source how fatigued the patient acts in everyday life; rule out depression; rule out a primary sleep disorder; rule out alcohol, sedating medications, and other drugs; rule out withdrawal from stimulants; rule out a systemic cause such as hypotension, hypoxemia, renal failure, liver failure, anemia, hyponatremia, hypothyroidism, vitamin D deficiency, and chronic urinary tract infection. If these are not present or fatigue persists after treatment, consider prescribing one or more of the following: a very gradually progressive exercise program, bright light treatment, complete alcohol cessation, a diet that is low in refined sugar, a stimulant, amantadine, and modafinil. Consider using a quantitative measure, such as The Fatigue Severity Scale.

Cognitive Function Characteristics of Parkinson’s Disease with Sleep Disorders

Objective. The aim of this study was to investigate the cognitive function characteristics of Parkinson’s disease (PD) with sleep disorders. Methods. Consecutive patients with PD (n=96), patients with primary sleep disorders (n=76), and healthy control subjects (n=66) were assessed. The patients with PD were classified into sleep disorder (PD-SD) and non-sleep disorder (PD-NSD) groups. Results. Among 96 patients with PD, 69 were diagnosed with a sleep disorder. There were 38 sleep disorder cases, 31 RBD cases, and 27 NSD cases. On the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and MoCA subtests, patients in the PD-SD, primary sleep disorder, and PD-NSD groups exhibited lower scores than those in the control group. Moreover, the PD-SD patients exhibited more significant cognitive impairment than was observed in the primary sleep disorder patients. In the PD-SD subgroup, the attention scores on the MoCA and on MoCA subtests were lower in the PD with RBD group than in the PD with insomnia group. Conclusion. PD with sleep disorders may exacerbate cognitive dysfunction in patients. PD associated with different types of sleep disorders differentially affects cognitive functions, and patients with PD with RBD exhibited poorer cognitive function than was seen in patients with PD with insomnia.

Fatigue

A systematic approach to fatigue: figure out how bad it is; rule out the complaint of concussion-related fatigue as an excuse to get out of school, work, or unpleasant chores at home by asking the collateral source about how fatigued the patient acts in everyday life; rule out depression; rule out a primary sleep disorder; rule out alcohol, sedating medications, and other drugs; rule out withdrawal from stimulants; rule out a systemic cause such as hypotension, hypoxemia, renal failure, liver failure, anemia, hyponatremia, hypothyroidism, vitamin D deficiency, or chronic urinary tract infection. If these are not present or fatigue persists after treatment, consider prescribing one or more of the following: a very gradually progressive exercise program, bright light treatment, complete alcohol cessation, a diet that is low in refined sugar, a stimulant, amantadine, and modafinil.

Insomnia Etiology and Comorbidity

Insomnia is an extremely prevalent condition, affecting large segments of the population. There is a broad spectrum of risk factors for this disorder, most of which are various types of social, economic, or interpersonal stressors. Risk factors include age, female gender (especially post- and perimenopausal women), divorce/separation/widowhood, psychiatric illness (mood and anxiety disorders), medical conditions, cigarette smoking, alcohol consumption, coffee consumption, and certain prescription drugs. It is important to recognize that the symptom of insomnia (ie, disturbed or poor quality sleep) may be due to the presence of another primary sleep disorder, such as restless legs syndrome, periodic limb movements in sleep, or sleep apnea.