SESSION TITLE: Diagnosis of Sleep Apnea
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 27, 2014 at 07:30 AM - 08:30 AM
PURPOSE: Despite the high prevalence of OSA in patients with co-morbidities routinely seen in hospitalized medical patients such as obesity, CAD, AFib, HTN, CHF, COPD, and DM, greater than eighty percent of patients with OSA remain undiagnosed. Previous research establishes that dedicated screening using established tools identifies a significant number of patients later confirmed to have OSA by PSG (polysomnography). Little is known about the rate of identification of patients at high risk for OSA in hospitalized patients without mandated screening. Weexamined how often acutely ill patients admitted to a medical service were recognized as high risk for OSA without dedicated screening tools, and if patients who had previously been diagnosed with OSA were recognized by the medical team.
METHODS: We screened 514 consecutive patients admitted to an inpatient medical service with the STOP BANG (SB) tool without the knowledge of the admitting team. The SB is an OSA screening tool that has been validated in the surgical setting. We then performed a retrospective chart review upon discharge to determine if medical residents and staff recognized the risk for OSA, or elicited a prior history of OSA in the patients whom we had screened prospectively. We also reviewed if treatment measures were initiated by the primary medical team in patients felt to be at risk for OSA, or in those with a prior diagnosis of OSA.
RESULTS: We found that 75.4 % of the patients we screened were at high risk for OSA by the STOP BANG tool but only 4.2% of patients were actually identified by the primary medical team as being at risk for OSA during their hospitalization. Among patients who reported a prior history of OSA, 56.7 % were identified by the primary medical team and 79.4% of these patients had PPV ordered during hospital stay. Patients with a higher BMI and greater neck circumference were more likely to be recognized as at risk for OSA by the medical team.
CONCLUSIONS: Without dedicated screening, few patients at high risk for OSA are identified by an inpatient hospital medical team. Higher BMI and greater neck circumference are characteristics that may be linked to recognition of risk for OSA in the absence of a dedicated screening tool.
CLINICAL IMPLICATIONS: Given that patients with OSA have higher hospital admission rates and healthcare utilization, and costs related to these patients decline after diagnosis and treatment, ongoing medical staff education, dedicated universal screening and treatment pathways are warranted.
DISCLOSURE: The following authors have nothing to disclose: Andrew Hameroff, Tiffany Dumont, Tejpreet Lamba, Daniel Shade
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