Identifying gaps in clinical evaluation and treatment of sleep-disordered breathing in women veterans

Isabel Moghtaderi; Monica R Kelly; Gwendolyn C Carlson; Constance H Fung; Karen R Josephson; Yeonsu Song; Dominika Swistun; Ruoyan Zhu; Michael Mitchell; Diane Lee; M Safwan Badr; Donna L Washington; Elizabeth M Yano; Cathy A Alessi; Michelle R Zeidler; Jennifer L Martin

doi:10.1007/s11325-022-02765-1

Identifying gaps in clinical evaluation and treatment of sleep-disordered breathing in women veterans

Sleep Breath. 2023 Oct;27(5):1929-1933. doi: 10.1007/s11325-022-02765-1. Epub 2022 Dec 16.

Authors

Isabel Moghtaderi^{1

2}, Monica R Kelly^{1

2}, Gwendolyn C Carlson^{3

4

5}, Constance H Fung^{1

2}, Karen R Josephson¹, Yeonsu Song^{1

2

6}, Dominika Swistun¹, Ruoyan Zhu⁷, Michael Mitchell¹, Diane Lee¹, M Safwan Badr^{8

9}, Donna L Washington^{2

4}, Elizabeth M Yano^{2

4

10}, Cathy A Alessi^{1

2}, Michelle R Zeidler^{1

11}, Jennifer L Martin^{12

13

14}

Affiliations

¹ Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
² Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
³ Department of Mental Health, VA Greater Los Angles Healthcare System, Los Angeles, CA, USA.
⁴ VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁵ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁶ School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA.
⁷ University of Arizona, Phoenix School of Medicine, Phoenix, AZ, USA.
⁸ Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
⁹ John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
¹⁰ Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
¹¹ Division of Pulmonary, Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
¹² Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. [email protected].
¹³ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. [email protected].
¹⁴ VA Sepulveda Ambulatory Care Center, 16111 Plummer Street (11E), North Hills, CA, 91343, USA. [email protected].

Abstract

Purpose: Sleep-disordered breathing (SDB) is a common sleep disorder in veterans; however, limited research exists in women veterans. We sought to estimate patterns of care in terms of evaluation, diagnosis, and treatment among women veterans with factors associated with elevated SDB risk.

Methods: Within one VA healthcare system, women identified through electronic health record data as having one or more factors (e.g., age >50 years, hypertension) associated with SDB, completed telephone screening in preparation for an SDB treatment study and answered questions about prior care related to SDB diagnosis and treatment.

Results: Of 319 women, 111 (35%) reported having completed a diagnostic sleep study in the past, of whom 48 (43%) were diagnosed with SDB. Women who completed a diagnostic study were more likely to have hypertension or obesity. Those who were diagnosed with SDB based on the sleep study were more likely to have hypertension, diabetes, or be ≥50 years old. Of the 40 women who received treatment, 37 (93%) received positive airway pressure therapy. Only 9 (24%) had used positive airway pressure therapy in the prior week. Few women received other treatments such as oral appliances or surgery.

Conclusions: Findings support the need for increased attention to identification and management of SDB in women veterans, especially those with conditions associated with elevated SDB risk.

Keywords: Positive airway pressure therapy; Sleep; Sleep apnea; Veterans; Women.

MeSH terms

Diabetes Mellitus*
Female
Humans
Hypertension* / diagnosis
Hypertension* / epidemiology
Hypertension* / therapy
Middle Aged
Obesity
Sleep Apnea Syndromes* / diagnosis
Sleep Apnea Syndromes* / epidemiology
Sleep Apnea Syndromes* / therapy
Veterans*

Abstract

MeSH terms

Grants and funding