A common-sense approach to chronic fatigue in primary care

Dc, Ang; Lh, Calabrese

doi:10.3949/ccjm.66.6.343

Cleveland Clinic Journal of Medicine

1999

DOI: 10.3949/ccjm.66.6.343

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A common-sense approach to chronic fatigue in primary care

Ang Dc

Calabrese Lh

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“…For many patient complaints, a patient's history is essential in the initial assessment by a physician; this is particularly true of chronic fatigue. 1 Patient presentations that are characterized by persistent fatigue and associated disability frequently occur without evident physical or psychological causes to explain the illness, 1,2 but are so common that one investigator states, "Our health services care for a population in which fatigue is so common as to be almost a normal consequence of life." 3 Epidemiological studies have estimated that about one in three people in the population experiences fatigue which is severe and long lasting and one in five reports fatigue lasting over 6 months.…”

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confidence: 99%

Medical Student Competence in Eliciting a History for ``Chronic Fatigue''

Papp¹,

Erokwu²,

Decker³

2001

Sleep Breath

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confidence: 99%

Medical Student Competence in Eliciting a History for ``Chronic Fatigue''

Papp¹,

Erokwu²,

Decker³

2001

Sleep Breath

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Primary Care: Is It the Setting to Address Sleep Disorders?

Dement

Netzer

2000

Sleep Breath

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lation than in the general population, and very likely at higher levels of severity. Why might this be true? One reason is the nature of medical practice, where most encounters (> 85%) are for chronic and acute disease. 1 This results in an enriched profile for risk factors. For example, in the Cleveland cohort studied with the Berlin Questionnaire (see Appendix), 50% of a consecutively studied primary care patient population was obese and/or hypertensive. 2 Moreover, such patients were more likely to visit their family doctor than healthy adults.Prior studies in primary care have emphasized a single sleep disorder. Several reports have emphasized insomnia in youthful 3-5 and geriatric populations. 6-7 Sochat and Ancoli-Israel 8 found 69% prevalence for insomnia in patients over 65 years of age. They suggest that the primary care population has a higher prevalence of insomnia than the general population because of concomitant psychiatric and medical illness.Stoohs et al. 9 showed a high prevalence of sleep disordered breathing in a sample of primary care patients. The high prevalence of sleep disordered breathing was confirmed in a larger sample by Netzer et al. 2 using the Berlin Questionnaire. Pediatricians first acknowledged the need for the family practitioner to recognize sleep disorders in the infants and children they cared for because parents often sought advice from their family doctor first before they went to a pediatrician or to one of the (rare) pediatric sleep specialists. [10][11][12] In 1993, the Wisconsin cohort study reported an obstructive sleep apnea population prevalence of 24% in adult men and 9% in adult women 13 , with 2 to 4% showing clear symptoms. Although obstructive sleep apnea was already identified as a public health problem, the Wisconsin cohort results removed all doubt of the high prevalence of this major sleep disorder. This is a difficult question because it is potentially embarrassing to show that quite unbeknownst to the physician, a river of sleep disorders is flowing through a clinic.Although largely ignored in the early evolution of sleep medicine, interest in the need to improve recognition of sleep disorders in primary care patient populations is beginning to increase. The study by Kushida et al. in this issue of Sleep and Breathing presents data strongly supporting a very high prevalence of sleep disorders in the primary care setting. These authors report that 60.1% of patients interviewed consecutively for one year presented unambiguous symptomatology at levels of severity deemed highly likely to be confirmed by polysomnographic testing. On the other hand, nearly all the symptomatic patients in the study of Kushida et al. had not had a prior sleep diagnosis. Moreover, in the entire scientific/clinical literature there is no evidence whatsoever that more than a tiny fraction of patients afflicted with sleep disorders receive specific diagnoses and the appropriate, beneficial treatment from primary physicians. This deplorable state of affairs co-exists with an enormous...

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Medical Student Competence in Eliciting a History for “Chronic Fatigue”

2001

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A common-sense approach to chronic fatigue in primary care

Cited by 4 publications

References 0 publications

Medical Student Competence in Eliciting a History for ``Chronic Fatigue''

Medical Student Competence in Eliciting a History for ``Chronic Fatigue''

Primary Care: Is It the Setting to Address Sleep Disorders?

Medical Student Competence in Eliciting a History for “Chronic Fatigue”

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