1184 Enhancing Diagnosis of Nightmare Disorder at an Academic Sleep Disorders Center: A Quality Improvement Initiative
Amanda Radtke, Aaron Burch, James R. Kang, Philip Cushman, H. Scheuller, Zahari N. Tchopev, Matthew S. Brock
Sleep May 1, 2025 DOI: 10.1093/sleep/zsaf090.1184 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Quality improvement project Peer reviewed |
|---|---|
| Sample size | 239 |
| Population | Patients referred to an academic sleep center, reported as service members |
| Measures | nightmare disorder index (NDI) |
| Topics | Dreaming |
| Key points | The nightmare disorder index identified probable or possible Nightmare Disorder in a large share of referred patients (19.76% probable and 39.52% possible at baseline), while confirmed clinical diagnoses were much rarer (2.99%). After adding NDI results to polysomnography reports, probable NDO was 13.89% and possible NDO 36.11%, with 4.17% diagnosed, which the authors suggest indicates the intervention improved diagnosis rates. |
Abstract
Nightmare Disorder (NDO) is estimated to impact at least 4% of the US adult population yet is reported to be much higher among service members (SMs). Our Center has previously reported 31.2% of referred SMs had probable NDO based on screening measures, yet only 3.9% reported nightmares as a reason for evaluation. No quality measures report on the rate of confirmed diagnosis, and more importantly, treatment of NDO or its sequelae. This quality improvement project sought to address the barriers to effective identification and diagnosis of NDO by implementing tiered Plan-Do-Study-Act (PDSA) cycles. Patients referred to our academic sleep center complete a nightmare disorder index (NDI) during their intake assessment. Retrospective chart review of May 2024 was performed to establish baseline rates of probable and possible NDO based on NDI responses, as well as rates of eventual NDO diagnoses at follow-up clinic appointments. The initial intervention instituted was to include the NDI as part of baseline characteristics listed at the top of polysomnography reports to prompt the provider at follow-up to address the finding. Chart review cycles were performed to assess the efficacy of this intervention in diagnosing NDO at follow-up. During baseline assessment period of May 2024, 167 new patients completed the NDI, with 33 (19.76%) scoring in the probable, and 66 (39.52%) in the possible NDO range. Ultimately, 5 (2.99%) of these patients were diagnosed with NDO after clinical assessment. The first intervention went into effect in July 2024. Subsequently, 72 patients completed the NDI, with 10 (13.89%) probable and 26 (36.11%) possible NDO. Of these, 3 (4.17%) patients were diagnosed with NDO after clinical assessment. This ongoing quality improvement project suggests the NDI is detecting probable and possible NDO at high rates in our patient population, consistent with prior reports. The baseline clinical diagnosis of NDO was concerningly low but the initial intervention improved the rate of diagnosis. Planned PDSA cycles include tracking and improving patient follow-up to better understand the sensitivity and specificity of using the NDI in our population, and educating patients and staff on the importance of appropriately diagnosing and treating NDO.