An Intervention Can Improve Medical Students' Recognition of Sleep Apnea

Chicago, IL - June 8, 2001

Obstructive sleep apnea is characterized by repetitive pauses in breathing during sleep due to the obstruction and/or collapse of the upper airway. It is usually accompanied by a reduction in blood oxygen saturation, which is followed by an awakening to breathe, termed an apnea event.

Consider this analogy: imagine putting your hand over your vacuum cleaner intake nozzle when the vacuum is turned on'. Your hand blocks all air from getting through (upper airway collapse) even though the vacuum cleaner is still applying suction (respiratory effort continues). The vacuum cleaner strains considerably as does the human body. If episodes are not recognized and treated, sleep apnea can be life threatening.

It is important, therefore, for physicians and health professionals to take reports about sleep disturbances or sleep irregularities very seriously and to investigate the nature of the problems reported. A study conducted by Klara K. Papp, Ph.D., and Kingman P. Strohl, M.D., of Case Western Reserve University reviewed the impact of additional training on sleep by introducing an interactive lecture demonstration on the topic of obstructive sleep apnea to third year medical students in their clinical years.

Medical students on their Internal Medicine clinical rotations from January of 1999 through July of 2000 were studied. Of the 259 students, half (n=130) received a lecture on obstructive sleep apnea, the other half (n=129) did not. At the end of the rotations, all students completed an Objective Structured Clinical Examination (OSCE) in partial fulfillment of the requirements of clerkship. The OSCE consists of 17-23 stations; one of the stations tested students' knowledge and comprehension of obstructive sleep apnea.

The students observed a videotaped sleeping patient and were asked to diagnose the patient and describe clinically relevant facts. The faculty raters were blinded as to which students had participated in the lecture on sleep apnea and which ones had not. Stations were scored using a uniform behavioral checklist. Students received full, partial or no credit for each item and the scores were summed across items and across stations for the overall OSCE scores.

Students who had received the lecture on obstructive sleep apnea scored significantly higher on that station than those who did not (19 vs. 16). Those who received the lecture were more able to list five symptoms of sleep apnea and to understand the cardiovascular diseases associated with sleep apnea and could more easily name the disorder.

The authors conclude that even relatively simple interventions can make a difference in terms of medical students' competence in recognizing and diagnosing obstructive sleep apnea.

In this study the students received a one-hour lecture on one specific sleep disorder: obstructive sleep apnea. Past research, however, has indicated that most medical students receive, on average, less than two hours of training in sleep medicine in four years of medical school.