Negar Almassi MPS[/caption]
Dr Brian Chia MPS[/caption]
COPD is significantly underdiagnosed
Associate Professor Debbie Rigby FPS[/caption]
Nicolette Ellis MPS[/caption]
A national education program for pharmacists funded by the Australian Government under the Quality Use of Diagnostics, Therapeutics and Pathology program.[/caption]
Both these disorders can occur separately, but if they co-occur, this is termed COMISA. Approximately 30–50% of people with OSA have comorbid insomnia, and 30–40% of people with chronic insomnia have comorbid OSA.9,12 A recent population-based study reported that 11% of Australian adults report symptoms of COMISA.13
The ‘gold standard’ measure of OSA presence and severity is an overnight sleep study (Table 1).25 The most common single metric to determine OSA presence and severity is the apnoea-hypopnoea index (AHI), representing the average number of airway narrowing and closure events occurring per hour of sleep.24 Identifying the most appropriate management approaches for OSA also requires consideration of lifestyle factors, symptoms and consequences, occupation, chronic conditions, and other sleep conditions. Self-report questionnaires may be used to screen for a high-risk of OSA and identify patients suitable for referral and consideration of overnight sleep study assessment (Table 1).24
Although evidence-based guidelines unanimously recommend avoiding long-term use of hypnotics, they are indicated for a minority of patients that present with severe acute insomnia that is causing significant psychological distress or functional impairment.29 Most people who experience short-term insomnia symptoms (1–2 weeks) can be reassured that sleep will return to ‘normal’ after the underlying precipitant has subsided, without targeted treatment (i.e. hypnotic medicines).29,33 For those who experience persistent insomnia, cognitive behavioural therapy for insomnia (CBTi) is the first-line treatment. Pharmacotherapy may be considered in patients with severe insomnia that is causing significant impairment or distress (e.g. times of acute work/exam stress, bereavement).34
Tailored recommendations for non-CPAP therapies may also be provided to patients with different levels of OSA severity and presenting features.17 For example, weight management advice where indicated, positional devices (in the presence of supine-predominant OSA), mandibular advancement splints (in patients with mild-to-moderate OSA), and upper airway surgery are effective treatments that may be tailored to each individual patient.24
Dr Alexander Sweetman (he/him) PhD
Senior Program Manager, and chair of the psychologist education subcommittee at the Australasian Sleep Association.
Associate Professor Sutapa Mukherjee (she/her) MBBS, FRACP, PhD
Respiratory and sleep physician, Associate Professor of Respiratory and Sleep Medicine at Flinders University and past President of the Australasian Sleep Association.
Professor Garun Hamilton (he/him) MBBS, FRACP, PhD
Respiratory and sleep physician, clinical professor at Monash Health and Monash University and President of the Australasian Sleep Association.
Professor John Turnidge AO[/caption]
References
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- MND Australia. Overview of MND: this information is for health professionals and service providers. 2021. At: www.mndaustralia.org.au/mnd-connect/for-health-professionals-service-providers/overview-of-mnd-for-health-professionals
- Thompson E. Pharmacist considerations for treating patients with ALS. US Pharm 2019;44(8):HS-1-HS-10.
- Gauld N. Living with motor neurone disease. Pharmacy today. 2023. At: www.pharmacytoday.co.nz/article/opinion/columns/living-motor-neurone-disease
- The International Alliance of ALS/MND Associations. What is ALS/MND? 2024. At: www.als-mnd.org/what-is-alsmnd/
- Ingre C, Roos PM, Piehl F, et al. Risk factors for amyotrophic lateral sclerosis. Clin Epidemiol 2015;7:181–93.
- Al-Chalabi A, Calvo A, Chio A, et al. Analysis of amyotrophic lateral sclerosis as a multistep process: a population-based modelling study. Lancet Neurol 2014;13(11):1108–13.
- Oliver D. Motor Neurone Disease: a family affair. 3rd edn. London: Sheldon Press; 2011.
- Shoesmith C, Abrahao A, Benstead T, et al. Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ 2020;192(46):e1453–68.
- Dharmadasa T, Henderson RD, Talman PS, et al. Motor neurone disease: progress and challenges. Med J Aust 2017;206(8):357–62.
- Gwathmey KG, Corcia P, McDermott CJ, et al. Diagnostic delay in amyotrophic lateral sclerosis. Eur J Neurol 2023;30:2595–601.
- Rossi S, ed. Riluzole. Australian medicines handbook; [updated Jan 2024]. At: https://amhonline.amh.net.au/chapters/neurological-drugs/drugs-other-neurological-conditions/riluzole?menu=hints
- Andrews J, Jackson CE, Heiman-Patterson TD, et al. Real-world evidence of riluzole effectiveness in treating amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020;21(7–8):509–18.
- Hardiman O, Al-Chalabi A, Chio A. et al. Amyotrophic lateral sclerosis. Nat Rev Primers 2017;3:17071.
- Anderson P, Abrahams S, Borasio GD, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS) – revised report of an EFNS task force. Eur J Neurol 2012;19(3):360–75.
- Jefferies KA, Bromberg MB. The role of the clinical pharmacist in a multidisciplinary amyotrophic lateral sclerosis clinic. Amyotroph Lateral Scler 2012;13(2):233–36.
