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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- Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49(6):822–30.
- Healthy male. Erectile dysfunction. 2020. At: www.healthymale.org.au/mens-health/erectile-dysfunction
- Liu Q, Zhang Y, Wang J, et al. Erectile dysfunction and depression: a systematic review and meta-analysis. J Sex Med 2018;15(8):1073–82.
- Chambers SK, Chung E, Wittert G, et al. Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment. Transl Androl Urol 2017;6(1):60–8.
- Prostate cancer foundation of Australia. Proscare: a psychological care model for men with prostate cancer. 2013. At: www.pcfa.org.au/media/195765/proscare_monograph_final_2013.pdf
- Shoshany O, Katz D, Love C. Much more than prescribing a pill – assessment and treatment of erectile dysfunction by the general practitioner. Australian Family Physician 2017;46(9).
- Burnett AL. The role of nitric oxide in erectile dysfunction: implications for medical therapy. J Clin Hypertens (Greenwich) 2006;8(12 Suppl 4):53–62.
- Burnett AL. The science and practice of erection physiology: story of a revolutionary gaseous molecule. Trans Am Clin Climatol Assoc 2019;130:51–9.
- Therapeutic Guidelines. Erectile dysfunction. 2024. At: https://tg.org.au
- eMIMs. 2024. At: www.emims.com.au
- Mulhall JP, Jenkins LC. Atlas of office based andrology procedures. 2017.
- Duncan C, Omran GJ, Teh J, et al. Erectile dysfunction: a global review of intracavernosal injectables. World J Urol 2019;37(6):1007–14.
- Rossi S, ed. Australian medicines handbook. 2024. At: https://amhonline.amh.net.au/
- Montorsi F, Guazzoni G, Bergamaschi F, et al. Effectiveness and safety of multidrug intracavernous therapy for vasculogenic impotence. Urology 1993;42(5):554–8.
- Baird B, Wajswol E, Ericson C, et al. Pre- and post-Injection needle pain in patients undergoing first intracavernosal injection. J Sex Med 2022;19(4):590–3.
