Prevalence and management of sleep disorders in the Veterans Health Administration

Folmer, Robert L.; Smith, Connor; Boudreau, Eilis; Hickok, Alex; Totten, Annette M; Kaul, Bhavika; Stepnowsky, Carl; Whooley, Mary A.; Sarmiento, Kathleen

doi:10.1016/j.smrv.2020.101358

Cited by 49 publications

(41 citation statements)

References 32 publications

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“…In both the current analysis and that of Alexander et al, relatively conservative criteria were used to define an insomnia diagnosis (i.e., ≥2 ICD codes occurring greater than 30 days apart but within 390 and 365 days, respectively). However, the discrepancy in prevalence estimates between medical record and interview-or survey-based studies is also apparent in studies that used medical record data but applied less stringent criteria for a diagnosis of insomnia (e.g., occurrence of a single insomnia diagnosis code, 7.4-11.8% [10]). Together, this suggests that insomnia is under-documented in the medical record and likely under-detected or under-diagnosed in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, administrative studies of VA electronic health records (EHR) estimate insomnia prevalence rates from 0.2% to 3.5% [6,7]. Though a 650% relative increase in the age-adjusted prevalence of insomnia was observed in veterans utilizing VA services between fiscal years 2000 and 2010 (from 0.2% to 1.5% [6]), there remains a notable discrepancy between reports of clinically significant insomnia symptoms [9] and expected diagnoses of insomnia in the medical record (7.4-11.8%; [7,10,11]).…”

Section: Introductionmentioning

confidence: 99%

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Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

Bramoweth

Tighe

Berlin

2021

IJERPH

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The objective was to examine insomnia and insomnia-related care within a regional network of Department of Veterans Affairs (VA) facilities since the VA roll-out of cognitive behavioral therapy for insomnia (CBT-I) in 2011. A retrospective analysis of VA electronic health records (EHR) data from 2011 to 2019 was conducted. The annual and overall prevalence of four insomnia indicators was measured: diagnoses, medications, consultations for assessment/treatment, and participation in CBT-I. Also examined were sociodemographic and clinical differences among veterans with and without an insomnia indicator, as well as differences among the four individual insomnia indicators. The sample included 439,887 veterans, with 17% identified by one of the four indicators; medications was most common (15%), followed by diagnoses (6%), consults (1.5%), and CBT-I (0.6%). Trends over time included increasing yearly rates for diagnoses, consults, and CBT-I, and decreasing rates for medications. Significant differences were identified between the sociodemographic and clinical variables across indicators. An evaluation of a large sample of veterans identified that prescription sleep medications remain the best way to identify veterans with insomnia. Furthermore, insomnia continues to be under-diagnosed, per VA EHR data, which may have implications for treatment consistent with clinical practice guidelines and may negatively impact veteran health.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

Bramoweth

Tighe

Berlin

2021

IJERPH

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“…Sleep and arousal disorders are prevalent in active military personnel and in Veterans. Deployment and combat exposure substantially increase the risk for insomnia and other sleep disorders in military personnel ( Caldwell et al, 2019 ; Colvonen et al, 2020 ; Folmer et al, 2020 ; Good et al, 2020 ). These findings correlate with the large increase in the diagnosis of sleep disorders in the VA in recent years ( Alexander et al, 2016 ; Martin et al, 2020 ).…”

Section: The Importance Of Sleep and Arousal For Mental And Physical ...mentioning

confidence: 99%

Translational approaches to influence sleep and arousal

Brown

Spratt

Kaplan

2022

Brain Research Bulletin

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“…The use of home sleep testing among Veterans has increased every year since 2000 and surpassed polysomnography (PSG) as the most common VHA testing method in 2018 [ 11 ]. Despite the high prevalence of OSA and a large number of comorbid conditions in affected patients, there have been no significant changes in clinical guidelines regarding the use of HSAT for the detection of OSA.…”

Section: Study Rationalementioning

confidence: 99%

“…VA is uniquely positioned to address both the efficacy of e-consultation (in place of an initial provider encounter) and the negative predictive value of HSAT because VHA has a large population of Veterans at increased risk for OSA who also exhibit substantial co-morbidities [ 11 ]. Furthermore, the VA healthcare model emphasizes high quality, high-throughput and timely access to care for Veterans.…”

Section: Introductionmentioning

confidence: 99%

Study protocol to assess de-implementation of the initial provider encounter for diagnosis and treatment of obstructive sleep apnea: the DREAM (Direct Referral for Apnea Monitoring) Project

et al. 2022

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Background Obstructive sleep apnea (OSA) is a very common and serious health condition which is highly prevalent among U.S. military Veterans. Because the demand for sleep medicine services often overwhelms the availability of such services, it is necessary to streamline diagnosis and treatment protocols. The goals of this study are to, (1) assess the efficacy of de-implementing the initial provider encounter for diagnosis and treatment of OSA; (2) determine the negative predictive value (NPV) of home sleep apnea testing (HSAT); (3) develop HSAT usage recommendations for various at-risk patient populations. Methods This is a large, pragmatic study that will take place in 3 VA sleep medicine programs: San Francisco, CA; Portland, OR; and Pittsburgh, PA. All Veterans referred for new sleep apnea evaluations at these sites will be included in this four-year study. Outcomes will include time from referral for OSA to sleep testing and treatment; positive airway pressure (PAP) treatment adherence measures; patient-reported clinical outcomes and measures of satisfaction; determination of the NPV of HSAT; HSAT usage recommendations for at-risk patient populations. Discussion The DREAM (Direct Referral for Apnea Monitoring) Project will inform sleep medicine providers and clinical organizations regarding strategies to streamline diagnosis and treatment protocols for OSA. Results of this study should have significant impact on clinical practices and professional guidelines. Trial registration The majority of this project is an observational study of clinical procedures. Therefore, clinical trial registration is not required.

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Prevalence and management of sleep disorders in the Veterans Health Administration

Cited by 49 publications

References 32 publications

Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

Translational approaches to influence sleep and arousal

Study protocol to assess de-implementation of the initial provider encounter for diagnosis and treatment of obstructive sleep apnea: the DREAM (Direct Referral for Apnea Monitoring) Project

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