Surveillance of Patients Who Are at High Risk for Obstructive Sleep Apnea in a Hospital Setting: A Retrospective Review

Abstract

Background: Obstructive sleep apnea (OSA) is defined as repetitive blockage of the upper airway during sleep, which is associated with many adverse health outcomes (ie, cardiovascular events, cognitive impairment, premature death). OSA affects an estimated 14-55% of the population and many are undiagnosed. A STOP-BANG screening tool combined with overnight oximetry (ONO) using the WatchPAT device was conducted to identify patients at the highest risk for undiagnosed OSA. This retrospective study aims to identify the total number of inpatients found to be at high risk for OSA as well as the correlates associated with positive ONO tests among these patients.

Methods: A STOP-BANG questionnaire developed by Piedmont Hospital was administered to all eligible patients admitted with the primary diagnosis of heart failure, atrial fibrillation, and COPD. After the questionnaire classified individuals as high-risk for OSA (STOP-BANG score of 3 or higher), ONO utilizing the Zoll Itamar WatchPAT wrist worn device were administered to those patients. Positive ONO (defined as an oxygen desaturation index [ODI] > 5) were provided with referrals to sleep medicine upon discharge. A retrospective chart review of all patients placed on this protocol was completed.

Results: A total of 747 patients were screened with the STOP-BANG assessment tool implemented on heart failure, atrial fibrillation, and COPD admission order-sets. 742 of the patients screened had a STOP-BANG score of 3 or more and required an overnight oximetry study. 568 ONOs were completed prior to discharge using a Zoll Itamar WatchPAT 200/300 wrist device. A total of 318 (56%) of the patients who completed an ONO had an ODI >15, indicating high risk for undiagnosed OSA. 98 (31%) of the 318 patients classified as high risk, scheduled an ambulatory appointment with a sleep doctor for further treatment. 67 (68%) of the 98 patients completed the scheduled outpatient office visit with a sleep provider. At the time of data collection, 36 (54%) of the scheduled patients, initiated CPAP therapy.

Conclusions: The STOP-BANG questionnaire combined with enhanced risk stratification through ONO with the WatchPAT device is an effective and optimal practice to identify risk for OSA. Our results yielded low adherence with follow-up and treatment once OSA risk was identified. Therefore, more work is needed on the hospital-to-home discharge planning and continuum of care to increase adherence with identified at risk patients.