Sleep Disorders in Aboriginal and Torres Strait Islander People and Residents of Regional and Remote Australia

Abstract

Study objectives: To compare the use of sleep diagnostic tests, the risks, and cofactors, and outcomes of the care of Indigenous and non-indigenous Australian adults in regional and remote Australia in whom sleep related breathing disorders have been diagnosed.

Methods: A retrospective cohort study of 200 adults; 100 Aboriginal and Torres Strait Islander and 100 non-indigenous adults with a confirmed sleep related breathing disorder diagnosed prior to September 2011 at Alice Springs Hospital and Cairns Hospital, Australia.

Results: Results showed overall Indigenous Australians were 1.8 times more likely to have a positive diagnostic sleep study performed compared with non-indigenous patients, 1.6 times less likely in central Australia and 3.4 times more likely in far north Queensland. All regional and remote residents accessed diagnostic sleep studies at a rate less than Australia overall (31/100,000/y (95% confidence interval, 21-44) compared with 575/100,000/y).

Conclusion: The barriers to diagnosis and ongoing care are likely to relate to remote residence, lower health self-efficacy, the complex nature of the treatment tool, and environmental factors such as electricity and sleeping area. Indigeneity, remote residence, environmental factors, and low awareness of sleep health are likely to affect service accessibility and rate of use and capacity to enhance patient and family education and support following a diagnosis. A greater understanding of enablers and barriers to care and evaluation of interventions to address these are required.

Commentary: A commentary on this article appears in this issue on page 1255.

Keywords: Australia; indigenous population; obstructive sleep apnoea; polysomnography; sleep.

Figure 1

Study sites (Alice Springs and Cairns) and associated health service catchment (gray).

Figure 2

Rate of sleep studies performed per 100,000 population (divided by whether study subsequently confirmed a sleep related breathing disorder or not) in far north Queensland (FNQ), Central Australia (CA) and (combined (FNQ+CA) stratified by whether Aboriginal and/or Torres Strait Islander or non-indigenous Australian patients. Comparative Medicare rebate data for sleep studies performed are provided for Queensland (QLD), Northern Territory (NT), and Australia (AUS) overall (www.medicareaustralia.gov.au). Note: Medicare data includes diagnostic as well as titration studies, and also repeated studies.