Sleep and the family doctor: time to lead.

In this issue of the Journal of the American Board of Family Medicine, the American Board of Family Medicine presents 4 original research articles about sleep-related topics. This signals a growing recognition of the role of sleep disorders/complaints in health and well-being and of sleep medicine’s relevance to the practice of family medicine. There are several themes that arise in these research reports. The first is the staggering prevalence of sleep disorders/complaints in the primary care setting. This is succinctly stated by Mold et al: “nearly all patients who visit [primary care clinics] regularly have sleep-related symptoms.” Pigeon et al are in the same ballpark statistically when, using a validated instrument, they find a 71% prevalence of disturbed sleep among urban patients. Though they studied a healthier population presenting for preventive medicine, Grover et al nevertheless discover that more than 50% of patients either reported a sleep complaint in a review of systems questionnaire or were found to be at high risk for sleep apnea judging by responses to the Berlin Questionnaire. A second theme is the impact of sleep disorders. The negative consequences of disturbed sleep involve multiple areas of health, including the cardiovascular, metabolic, hormonal, and immune systems; mental health; and cognitive function. Tandeter et al’s study, simply by virtue of its topic, reveals the protean side of sleep disorders: they frequently masquerade as other diagnoses, in this case as benign prostatic enlargement. Similarly, previous reports have indicated that primary sleep disorders may be incorrectly diagnosed as depression, chronic headache, or attention deficit disorder because of an overlap in symptoms. These 2 considerations—burden of sleep disorders to multiple physiologic systems and the potential for misdiagnosis—compel us to improve our recognition and response to sleep disorders/complaints. The third theme is the apparent reticence on the part of family physicians to take action when confronted with sleep complaints. Perhaps they are overwhelmed by the sheer volume of the complaints. Grover et al report that only 11% of individuals who reported sleep complaints underwent any subsequent diagnostic testing. This study includes physicians who regard themselves as educated about and “on board” with the significance of obstructive sleep apnea, and the authors conclude that there is a gap between “factual knowledge and appropriate clinical behaviors.”