title: A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial.
abstract: BACKGROUND
  Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the number of participants identified in RAO or RA+ group who were likely to have and consequently be diagnosed with OSA. Further outcomes included the number of participants identified as being at risk for, referred for, taking-up referral for, and then diagnosed with OSA, insomnia, and/or restless legs syndrome (RLS) in either group.
  
  
  METHODS
  In a cluster-randomized trial, participants were recruited through 23 community pharmacies. Using validated instruments, 325 (RAO = 152, RA+ = 173) participants were screened for OSA, insomnia, and RLS.
  
  
  RESULTS
  218 (67%) participants were at risk of OSA, insomnia or RLS and these participants were referred to their primary physician. The proportion of screened participants identified as being at risk of OSA was significantly higher in the RA+ group (36% in RAO vs. 66% in RA+, OR 3.4, 95% CI (1.8-6.5), p<0.001). A 12-month follow-up was completed in 125 RAO and 155 RA+ participants. Actual referral uptake was 34% RAO, 26% RA+, OR 4.4, 95% CI (1.4-19.2), p = 0.31. The OSA diagnosis rate was higher in the RA+ arm (p = 0.01). To yield a single additional confirmed OSA diagnosis, 16 people would need to be screened using the RA+ protocol.
  
  
  CONCLUSIONS
  These results demonstrate that utilising either screening method is feasible in identifying individuals in the community pharmacy setting who are likely to have OSA, insomnia and/or RLS. Secondly, adding an objective marker of OSA to a questionnaire-based prediction tool resulted in more confirmed OSA diagnoses.
  
  
  BACKGROUND
  ACTR.org.au ACTRN12608000628347.
authors: Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia; The Centre for Integrated Research and Understanding of Sleep (CIRUS), The University of Sydney, Sydney, NSW, Australia.
authors: Joanne M
authors: JM
authors: Fuller
authors: Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Centre for Integrated Research and Understanding of Sleep (CIRUS), The University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
authors: Keith K
authors: KK
authors: Wong
authors: Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Centre for Integrated Research and Understanding of Sleep (CIRUS), The University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
authors: Ronald
authors: R
authors: Grunstein
authors: Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
authors: Ines
authors: I
authors: Krass
authors: Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
authors: Jayshree
authors: J
authors: Patel
authors: Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia; The Centre for Integrated Research and Understanding of Sleep (CIRUS), The University of Sydney, Sydney, NSW, Australia.
authors: Bandana
authors: B
authors: Saini
mesh_terms: D001315:Australia; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010594:Pharmacies; D017286:Polysomnography; D012017:Referral and Consultation; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000175:diagnosis*