Jennifer Fisher Wilson
Wilson J.; Is Sleep the New Vital Sign?. Ann Intern Med. 2005;142:877-880. doi: 10.7326/0003-4819-142-10-200505170-00026
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Published: Ann Intern Med. 2005;142(10):877-880.
Does it seem as though everybody is tired all the time? In a nation where people value long hours of hard work, guzzle more than 100 million cups of coffee a day, and watch television obsessively, sleep has suffered. Average nightly sleep duration has fallen from approximately 9 hours in 1910 to 7 hours in 2002. Many people often sleep no more than 5 to 6 hours a night, even though studies show that most people need between 7 and 8 hours. An estimated 20% of the population regularly experiences fits of irresistible daytime sleepiness.
Sleep deprivation is not always the result of lifestyle choices or nighttime work schedules (1 in 5 workers are employed in shift work). Sleep disorders can also be at fault. An estimated 10% to 15% of Americans have severe or chronic insomnia—difficulty initiating or maintaining sleep or waking too early—according to the National Institutes of Health. Sleep apnea also disrupts the sleep of an estimated 5% of Americans, leading to as many as hundreds of awakenings a night when the victims of this disorder struggle to breathe. Restless legs syndrome also causes frequent awakening among 5% to 10% of the U.S. population. People with this disorder awaken after moving their lower extremities to relieve constant, unpleasant sensations in the legs and feet.
Thomas W. Filardo
May 19, 2005
Sleep is not a vital sign
To the Editor: No one doubts the seriousness nor the severity of sleep irregularities attendant upon the too-busy individual of the current era. However, the attempt to dub it a vital sign (1) is destined to failure. A sign, we would recall from those early days of physical diagnosis class, is an objective indicator of disease. Sleep deprivation and sleep problems may manifest through a variety of signs, but the issue in itself is either a symptom, a diagnosis, or both; but it is not a sign. There is a competition for ranking as a fifth vital sign: smoking status has been suggested (2); pain has been proffered to fill the slot in many nursing and medical journals (3, e.g.); other offerings may have eluded this reader's eye. Stedman's 26th edition defines the vital signs as temperature, respiratory rate, and blood pressure. Dorland's 30th edition also lists three: pulse, respiration, and temperature. While most authorities would include all four, and most clinical students and practitioners would likely list the quartet, it is important not to meddle in some well-established paradigm, particularly by muddying the clear distinction between symptom and sign, integral parts of the physical diagnosis exercise which remains responsible for the majority of clinical diagnoses. Let's wake up and cease losing sleep over time-wasting exercises in semantics.
Sincerely, Thomas W. Filardo, MD, FAAFP 3724 Monet's Lane Evendale, OH 45241 513.652.3054 513.769.6542 fax firstname.lastname@example.org
1. Wilson F. Is Sleep the New Vital Sign? Ann Int Med 2005 May 17; 143 (10):877. 2. Miller M. Smoking status should be the fifth vital sign. World Med J (United States), 2000 Jun, 99(3): 9-10 3. Lynch M Pain as the fifth vital sign. J Intraven Nurs (United States), 2001 Mar-Apr, 24(2): 85-94
[Potential Financial Conflicts of Interest: None I am, incidentally, the Chief Lexicographer and New Terms Editor of Stedman's Medical Dictionary, but the issue covered in this letter would in no way affect the minimal financial remuneration I receive for that responsibility, nor would it alter the sales of the volume. The new edition, currently in proof, shall list four vital signs, as it was the article under discussion which led me to discover the omission.]
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