Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care—Associations with sleep complaints, depressive symptoms and global perceived health

Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.

A Qualitative Study of Individual and Organizational Learning through Physiotherapists’ Participation in a Research Project

The need for evidence-based practice has been recognized by physiotherapy organizations over the past decades. Earlier studies have documented facilitators and barriers that affect the use and implementation of evidence-based practice. Less is known about what kind of interventions might be useful to implement evidence-based practice. This study explores what physiotherapists learn through participation in a research project relevant to their professional development towards achieving a more evidence-based physiotherapy practice. To what extent this learning was transferred to colleagues for organizational learning is also examined. This study was set in Sweden, where health care is publicly funded. Patients do not need a referral from a physician to consult a physiotherapist. Eleven interviews were conducted with physiotherapists who had participated in a randomized, controlled, multicenter, physiotherapy intervention investigating neck-specific exercise for patients with whiplash disorder. Gadamer’s hermeneutics was used to analyze the data. The physiotherapists described a range of learning experiences from their project participation, including instrumental learning (the concrete application of knowledge to achieve changes in practice) and conceptual learning (changes in knowledge, understanding or attitudes). The research project enabled the physiotherapists to develop new treatment techniques for broader application and extend their competence in techniques already known (instrumental learning). The physiotherapists believed that project participation enhanced their overall competence as physiotherapists, increased their job motivation and strengthened their self-confidence and self-efficacy (conceptual learning). Physiotherapists’ participation in the research project yielded many individual learning experiences, fostered positive attitudes to research and was conducive to achieving a more research-informed physiotherapy practice. Participation was associated with a deeper understanding of the challenges involved in conducting research. The transfer from individual learning to the wider organization in terms of organizational learning was limited.