Screening for Obstructive Sleep Apnea in the Primary Care Setting

Purpose: The purpose was to find out if screening for obstructive sleep apnea in the primary care setting using a questionnaire increases referrals for further sleep studies. The goal was to increase the number of referrals for follow-up sleep studies. Background: Sleep apnea is a sleep and respiratory disorder that causes frequent wakings in the night due to the throat muscles collapsing and causing the person to wake up to get needed oxygen. This disorder affects more than 22 million Americans and has a 2.47 increased morbidity and mortality risk if left untreated. Studies show that as many as 1 in 5 individuals struggle with sleep disordered breathing and 80% of these disorders go undiagnosed. Untreated sleep apnea has been linked to cardiovascular disease, hypertension, diabetes, strokes, and depression. There is currently no routine screening for sleep apnea in the primary care setting, but literature shows screening with the STOP-BANG Questionnaire increases follow-up for sleep studies and earlier treatment. The STOP-BANG Questionnaire has better sensitivity and specificity compared to other tools tested. Methods: The STOP-BANG Questionnaire was implemented to screen overweight patients with hypertension within one primary care practice for one month and referrals for follow-up were compared to the one month prior. A positive screen was a score of 4 or higher on the questionnaire. The post-intervention total was compared to the pre-intervention total and success was shown if the number of referrals increased by more than 10%. Results: Prior to the intervention, the clinic referred and set up four patients for follow-up sleep studies. Post intervention, the clinic referred and set up eight patients for follow-up sleep studies. There was a 100% increase in referrals in the post intervention group. Out of 12 participants, 2 screened negative, 10 screened positive, 2 refused referral while 8 accepted the referral for follow-up. Conclusion: The use of the STOP-BANG