Obstructive Sleep Apnea Screening in Primary Care

Abstract

Purpose: To screen high-risk for obstructive sleep apnea (OSA) using the STOP-BANGquestionnaire (SBQ) in a primary care setting to increase the number of referrals to sleep studies. Background: OSA is an independent risk factor for cardiovascular disease and can lead to a multitude of health problems. However, OSA is not routinely screened for in primary care, and it is estimated that 80-90% of people remain undiagnosed. Methods: The SBQ was administered to patients age 40+ with hypertension and/or obesity at a primary care clinic in Mesa, AZ, over one month. Screenings were administered by either the primary investigator (PI) or the medical assistants (MAs), and providers decided if a referral would be made for the screened patient. Data points were collected each plan-do-study-act (PDSA) cycle and were used to develop interventions for improvement for the next cycle. Results: Pre-intervention sleep study referrals totaled 13, and post-intervention referrals totaled 31. PDSA cycle one saw 12.1% of eligible people screened, cycle two 15.6%, cycle three 28.7%, and cycle four 31%. The rate of positive screens given referrals each cycle was variable: week one 53.8%, week two 50%, week three 55%, and week four 42.8%. The interventions implemented each PDSA cycle are as follows: 1) staff education; 2) re-education and introductory screening prompt for MAs; 3) information flyers hung up; and 4) re-education. Conclusions: Routinely screening high-risk patients for sleep apnea with the SBQ increased the referral rate for sleep studies. However, this project identified barriers to patients completing a sleep study which impacted the number of positive screens receiving referrals.