Tests
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Aanpak van slaapklachten en insomnie (slapeloosheid) bij volwassenen in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2018Prise en charge des problèmes de sommeil et de l’insomnie chez l’adulte en première lignePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 20181st tests to order
sleep diary
Test
Facilitates communication between doctor and patient. A questionnaire is filled out by the patient each morning to describe the quality and quantity of the previous night's sleep, including the time entering the bed and leaving the bed, sleep latency, total sleep time, number of awakenings, and subjective assessment of sleep restfulness. This is completed without relying on time cues during the night.
Result
poor-quality sleep, reduced total sleep time, delayed sleep onset, multiple and/or early-morning awakenings
Pittsburgh Sleep Quality Index (PSQI)
Test
The PSQI measures 7 areas of sleep over the last month: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Patients rate themselves on each of these 7 domains. Scoring of answers is based on a 3-point Likert-style scale. A global sum of 5 or greater indicates a poor sleeper.[107]
Result
≥5
Insomnia Severity Index (ISI)
Test
The ISI is a 7-item questionnaire using a 5-point Likert-style scale. Scores can range from 0 to 28, with a cutoff score of 8 suggesting the presence of clinical insomnia. The questionnaire has 3 questions assessing the severity of insomnia and 1 question analyzing satisfaction with current sleep pattern, sleep interference with daily function, awareness of sleeping problem for others, and concern about sleeping problems.[97]
Result
0 to 8
Stanford Sleepiness Scale (SSS)
Test
The SSS rates sleepiness on a scale of 1 (very awake) to 7 (very sleepy).[96]
Result
7
Epworth Sleepiness Scale (ESS)
Test
The ESS rates sleepiness in 8 categories on a 0 (no chance of dozing) to 3 (high chance of dozing) scale.[100]
Result
≥9
Athens Insomnia Scale (AIS)
Test
The AIS is a questionnaire based on the World Health Organization International Classification of Diseases (ICD-11) diagnostic criteria for insomnia. It rates sleep difficulties in 8 categories on a 0 to 3 scale ("no problem" to "very problematic").[101]
Result
≥6
Generalized Anxiety Disorder-7 (GAD-7)
Test
The GAD-7 is a questionnaire to perform initial screening for generalized anxiety disorder. It rates anxiety in 7 questions on a 0 to 3 scale ("not at all" to "nearly every day").
Result
0-27
Patient Health Questionnaire-9 (PHQ-9)
Test
The PHQ-9 is a self-administered questionnaire to screen for depression, which scores each of the 9 DSM-IV criteria as 0 ("not at all") to 3 ("nearly every day").
Result
0-27
Tests to consider
polysomnography (PSG)
Test
Best test for evaluating sleep, but rarely required for the diagnosis of insomnia. Typically ordered when sleep-disordered breathing or periodic limb movement disorder is suspected or when treatments are unsuccessful.
Do not routinely perform PSG in patients with chronic insomnia unless there is concern for a comorbid sleep disorder.[2][103][104]
PSG abnormalities in patients with insomnia include longer latency to persistent sleep, higher amounts of wakefulness after sleep onset, less total sleep time and sleep efficiency, and higher number of awakenings than those without insomnia. However, PSG results may be normal in certain patients with psychophysiologic insomnia (so called "reverse first night effect") or environmentally induced sleep disorder.
Result
variable
actigraphy
Test
Actigraphy performed for several days, together with a sleep diary, may aid diagnosis, particularly when the sleep history is inconsistent or unreliable.
Result
may show abnormal circadian rhythm patterns or sleep disturbances and reveal presence of paradoxical insomnia or other cause for discrepant subjective sleep disturbance reporting
thyroid-stimulating hormone (TSH)
Test
If thyrotoxicosis or hyperthyroidism is suspected as a contributing cause of insomnia, TSH is evaluated to determine thyroid abnormalities.
Result
low
CBC and iron studies
Test
CBC with differential and iron binding studies should be requested if the patient reports symptoms of restless legs syndrome.
Result
low hematocrit/hemoglobin, abnormal iron finding results
urine or blood substance use panel
Test
Ordered if substance use disorder is suspected.
Result
presence of substance
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