Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis

Grande, Michael Le; Jackson, Alun C; Beauchamp, Alison; Kerr, Debra; Driscoll, Andrea

doi:10.1016/j.sleep.2021.02.021

Cited by 7 publications

(5 citation statements)

References 185 publications

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“…16 We used a PSQI total score cutoff point of greater than 5 to define clinically significant poor sleep quality. 17 In this pilot study, the PSQI reliability (Cronbach α) for the 7 component scores was 0.775. Other studies of the PSQI with patients with dysrhythmia have reported Cronbach α scores showing good internal reliability ranging from 0.75 to 0.85.…”

Section: Study Measuresmentioning

confidence: 68%

“…The 7 component scores are summed to yield a PSQI total score (named the global score in the original validation study report) that ranges from 0 to 21, with a higher score indicating worse sleep quality 16 . We used a PSQI total score cutoff point of greater than 5 to define clinically significant poor sleep quality 17 . In this pilot study, the PSQI reliability (Cronbach α ) for the 7 component scores was 0.775.…”

Section: Methodsmentioning

confidence: 99%

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Self-reported Sleep Quality Before and After Atrial Fibrillation Ablation

2022

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Background: Poor sleep quality is highly prevalent in atrial fibrillation (AF) with reported links between worse sleep quality and higher AF severity. Little research has examined whether sleep quality changes after AF ablation despite it being a routinely performed procedure. Objective: The aim of this study was to evaluate self-reported sleep quality before and after AF ablation and to examine whether sleep quality differs by AF severity or sex. Methods: This longitudinal pilot study assessed sleep using the Pittsburgh Sleep Quality Index at preablation and at 1, 3, and 6 months after ablation. Atrial fibrillation disease severity was assessed by the Canadian Cardiology Society Severity of AF scale. Outcomes were analyzed using descriptive statistics, Spearman ρ correlations, and multilevel longitudinal models. Results: The sample (N = 20) was 55% female with a mean age of 65 (±7) years. Poor sleep quality (mean Pittsburgh Sleep Quality Index scores > 5) was evident at all time points. Improvement was noted at 3 months (moderate effect size d = 0.49); and negligible further improvement, from 3 to 6 months post ablation. Improvement was seen primarily in male subjects (large effect size d = 0.89 at 3 months), with smaller improvements for female subjects. Although Severity of AF scale scores were not correlated with sleep quality, Severity of AF scale severity scores did significantly improve over time. Conclusions: Patients with AF have poor sleep quality that improves for the first 3 months after AF ablation, with men showing more improvement than women. A more accurate understanding of the sleep challenges after AF ablation could lead to development of more realistic patient education and improve patient self-management.

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Section: Study Measuresmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Self-reported Sleep Quality Before and After Atrial Fibrillation Ablation

2022

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“…Given the high prevalence of anxiety and depression in cardiac patients (Murphy, Le Grande, et al, 2019) and the close relationship between insomnia, depression and adverse prognosis (Frojd et al, 2022; Le Grande et al, 2006), it is tempting to argue that screening for sleep disorders should be incorporated within existing psychosocial screening protocols, without adding excessive burden to the routine of nurses. (Le Grande, Jackson, et al, 2021). Our qualitative results here, however, indicate that this should be undertaken in consultation with nurses and other HCPs so that they better understand the benefit to the patient.…”

Section: Discussionmentioning

confidence: 99%

“…A joint Australian Centre for Heart Health (ACHH)/ACRA position statement (Le Grande et al, 2016) has advocated screening for OSA using brief, practical and validated instruments such as the STOP‐Bang Questionnaire (Chung et al, 2008). In a recent meta‐analysis of psychometric properties for sleep instruments suitable for cardiac patients (Le Grande, Jackson, et al, 2021), we identified a number of brief, valid, reliable and practical instruments which have been used regularly in research about sleep disorders but their specific use by nursing and other healthcare professionals (HCP) as a screening tool is relatively low (Jackson et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

Grande

Murphy

Kerr

et al. 2023

Journal of Advanced Nursing

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AimsTo examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings.DesignA qualitative descriptive study. Data were collected via semi‐structured interviews.MethodsIn March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized.ResultsSix themes and 20 sub‐themes were identified. Non‐validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed.ConclusionIntroduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness.ImpactsThe findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post‐cardiac event counselling.Reporting MethodAdherence to COREQ guidelines was maintained.Patient or Public ContributionNo Patient or Public Contribution as this study explored health professionals' experiences only.

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“…Of patients screened, there were 62 patients identified as high risk for sleep apnea without sleep study referrals, accounting for 22% of total screened participants. Based on the high sensitivity of the STOP-Bang questionnaire, 12,13,15 it would be expected that a proportion of these individuals would be diagnosed with sleep apnea if they were to undergo testing. There were a substantial number of participants that were not referred for sleep studies based on high-risk screening scores alone.…”

Section: Discussionmentioning

confidence: 99%

Identifying Obstructive Sleep Apnea Risk Using the STOP-BANG Questionnaire in a Cardiology Clinic

Rogel,

Iverson,

Hall

2023

J Healthc Qual

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Untreated obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality, warranting enhanced awareness, screening, and action among healthcare providers to optimize patient outcomes. Attempting to address the potential under detection of OSA, this quality improvement project implemented the STOP-Bang Sleep Apnea Questionnaire at a cardiology clinic, with the goals to stratify risk for OSA in 100% of patients and increase provider referral of high risk patients for sleep studies. The setting was an outpatient cardiology clinic in Pensacola, Florida. The sample included new and existing patients 18 years or older who had one or more of the following diagnoses: hypertension, heart failure, coronary artery disease, atrial fibrillation, or arrhythmia. Methods involved collecting and comparing preintervention sleep study referral rate data with 6-week STOP-Bang questionnaire implementation data. Results demonstrated a 65% (279 of 428 patients seen) screening implementation rate and a modest but statistically significant increase in the overall referral rate from 2.6% preintervention to 5.1% postintervention (p = .040). Overall, standard use of the STOP-Bang questionnaire may enable higher detection and referral of OSA.

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Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis

Cited by 7 publications

References 185 publications

Self-reported Sleep Quality Before and After Atrial Fibrillation Ablation

Self-reported Sleep Quality Before and After Atrial Fibrillation Ablation

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

Identifying Obstructive Sleep Apnea Risk Using the STOP-BANG Questionnaire in a Cardiology Clinic

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