{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:22:36Z","timestamp":1769156556956,"version":"3.49.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009913","name":"Naval Medical Center San Diego","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009913","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Clin Sleep Med"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study objectives<\/jats:title>\n                    <jats:p>Nightmare Disorder (NDO) is an underdiagnosed sleep disorder causing significant impairment, particularly in active duty U.S. military personnel who experience unique stressors. Despite 59.28% of referred service members reporting nightmares and 19.76% screening positive for probable NDO, baseline diagnosis rate was only 0.60%. Our quality improvement project aimed to improve identification and diagnosis of NDO among active duty service members at our sleep disorders center by increasing the confirmed diagnosis rate from 0.60% to at least 5% within 12\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A quality improvement initiative utilizing tiered Plan-Do-Study-Act cycles was implemented over seven months. Interventions included standardizing documentation of Nightmare Disorder Index results on polysomnography reports, targeted provider education, and chart flagging for patients screening positive for probable NDO. Diagnostic and process data were collected at baseline and following each intervention cycle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The diagnosis rate of NDO increased from 0.60% at baseline to 9.12% after three Plan-Do-Study-Act cycles. The percentage of patients with probable NDO who were ultimately diagnosed (recognition rate) rose from 3.03% to 55.32%. Interventions were implemented without delaying care or increasing staff burden, surpassing the goal diagnosis rate of at least 5% within the target timeframe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our interventions led to meaningful increases in NDO diagnoses that exceeded project goals. Given the significant effect of sleep disturbances and heightened mental health risks in the military, identification of this underdiagnosed disorder is clinically important and serves as the essential first step toward ensuring affected individuals receive appropriate treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Brief summary<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Current knowledge\/study rationale<\/jats:bold>\n                      :\u00a0Nightmare Disorder is significantly underdiagnosed in active duty service members despite causing substantial impairment and being highly prevalent in this population who face unique stressors. Sleep disorders centers often fail to identify and diagnose this condition even when service members report nightmares and screen positive on validated assessment tools.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Study impact<\/jats:bold>\n                      :\u00a0This quality improvement initiative demonstrates that systematic interventions including standardized screening documentation, provider education, and proactive chart flagging can dramatically increase nightmare disorder diagnosis rates in military healthcare settings. The successful implementation of these workflow-oriented processes provides a replicable model for other military and civilian sleep centers to improve identification of this underdiagnosed condition, serving as an essential first step toward ensuring affected patients receive appropriate treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44470-025-00016-0","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T17:09:28Z","timestamp":1769101768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enhancing identification and diagnosis of nightmare disorder in active duty patients at a sleep disorders center: A quality improvement initiative"],"prefix":"10.1007","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8295-5683","authenticated-orcid":false,"given":"Amanda","family":"Radtke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahari","family":"Tchopev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Cushman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Burch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. 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Work for this study was performed at Wilford Hall Ambulatory Surgical Center, JBSA Lackland, TX. The views expressed are those of the presenters and do not reflect the official views or policy of the Department of Defense or its components. No author has any financial interests or connections, direct or indirect, or other situations that might raise the question of bias in the work reported or the conclusions, implications, or opinions stated. No author received funding from commercial or other sources, has pertinent personal relationships, or direct academic competition related to this work.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the 59th MDW Institutional Review Board (Date 16 August 2024\/FWH20240121N\/ref#975673).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19"}}