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Screening Practices for Obstructive Sleep Apnea in a Pulmonary Hypertension Population FREE TO VIEW

Shilpi Bajaj, MD; Christina Holcroft, DSc; Ioana Preston, MD; Nicholas Hill, MD; Kari Roberts, MD; Khalid Ismail, MD
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Tufts Medical Center, Boston, MA

Chest. 2013;144(4_MeetingAbstracts):852A. doi:10.1378/chest.1699998
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Obstructive Sleep Apnea (OSA) is a prevalent, yet underdiagnosed contributor to pulmonary hypertension (PH). Despite recent recommendations to screen PH patients for OSA, there is currently no standardized screening protocol. We aimed to characterize current screening practices at a university-based pulmonary hypertension center.

METHODS: Single center retrospective chart review of patients undergoing evaluation for PH at Tufts Medical Center from 2005 to 2012. Patients with PH (resting mean pulmonary artery pressure ≥ 25 mm Hg) were included if they had at least 3 clinic visits, and were excluded if they had a prior diagnosis of OSA. Clinic notes were reviewed for the presence of pre-specified OSA risk factors and physical findings including snoring, witnessed apnea, choking/gasping during sleep, daytime sleepiness, fatigue, Epworth sleepiness scale, body mass index (BMI), Mallampati score, neck circumference or the use of a screening questionnaire. Recommendation for polysomnography (PSG) by the attending physician was also recorded.

RESULTS: Of 235 patients undergoing right heart catheterization during the study period, 81 patients met inclusion criteria. The study population was predominantly female (60%) with a mean age of 63 ± 14 years and a BMI of 27 ± 6 kg/m2 (both mean ± SD). No OSA risk factors were documented in 21/81 patients (26%), and only one risk factor was documented in 22/81 patients (27%). When documented, the most frequently assessed risk factors included Mallampati score (83%), daytime sleepiness (43%), snoring (43%), and fatigue (43%). We found a positive association between patient reported daytime sleepiness, and referral for PSG (p =0.04). BMI did not correlate with referrals for PSG (p = 0.35).

CONCLUSIONS: Screening PH patients for OSA at our center was inconsistent. Half the patients had one or no risk factors documented. Referral for PSG was only associated with reporting of daytime somnolence, but no other OSA risk factors.

CLINICAL IMPLICATIONS: The impact of a standardized protocol on the rate of OSA screening and clinical outcomes in PH patients needs to be examined.

DISCLOSURE: The following authors have nothing to disclose: Shilpi Bajaj, Christina Holcroft, Ioana Preston, Nicholas Hill, Kari Roberts, Khalid Ismail

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