Performance of sleep histories in an ambulatory medicine clinic - Impact of simple chart reminders

Background: The sleep history is essential to recognizing clinically import ant sleep disorders, but little is documented about its performance in the primary care setting, Study objectives: To estimate the frequency of documented sleep histories b y medical house officers (HOs) in an ambulatory medicine clinic and to asse ss whether a chart reminder Influences their performance, Design: We reviewed the performance of medical HOs after introduction of a medical record form that included a simple sleep history prompt among remin ders relating to health promotion. For each of 108 HOs, we randomly selecte d a chart with a sleep history prompt and one without. Results: Any sleep history was documented in only 37 of 216 medical records (17%), including 21 of 122 patients (17%) with risk factors for obstructiv e sleep apnea (OSA). Use of chart reminders was associated with nearly a fi vefold increase of sleep histories (29% vs 6%, p < 0.001), and charts with prompts had more notations about specific sleep complaints (2.6 +/- 0.9 vs 1.0 +/- 0.0 notes per patient, p < 0.0001), Sleep histories were recorded l ess often (p < 0.001) than histories of cigarette smoking or alcohol use, A lthough 24% of physicians appeared to he influenced by the prompt, sleep pr oblems were included on problem lists of only sir patients (3%). Overall, t he frequencies of diagnostic studies (1% of all patients, 6% of those with sleep histories) or documented therapeutic recommendations (0%) relating to sleep were low, whether or not chart reminders were used, with sleep testi ng obtained in only one patient. Sleep interventions were documented less o ften than smoking cessation or weight. loss (p < 0.002). Conclusions: Sleep histories are seldom documented by medical HOs, even in patients at risk for OSA. Use of a simple chart reminder was associated wit h an increased frequency of recorded sleep histories, but had no clear impa ct on diagnosis or treatment, Lf sleep problems and their management are to be prioritized appropriately, then the obstacles to obtaining sleep histor ies and to following up cues to deep disorders must be clarified and overco me.