Implementing Protocol for Obstructive Sleep Apnea Screening in the Primary Care Setting

Aim: 1) To implement obstructive sleep apnea (OSA) screening of at -risk patients in a primary care setting; 2) to evaluate and refer screened participants to sleep studies since early identification of OSA symptoms is an important initial step in reducing the burden of undiagnosed OSA disease.

Method: Participants completed the STOP-Bang questionnaire and those considered to be at risk were referred for sleep studies for disease identification, categorization, and treatment.

Results: Prevalent OSA screening and referral rates at the clinic prior to project implementation was 3% and 0% respectively, compared to the corresponding rates of 43% and 39% post project implementation. Out of 187 participants screened between January and April 2018, 61% had scores of 3 and higher on the STOP-Bang questionnaire, however, only 39% of the at-risk participants agreed to undergo sleep studies. Those who declined sleep study referrals were mostly participants who were not experiencing higher burden of sleep deprivation. Out of 45 participants who underwent sleep studies, 67% were diagnoses with moderate to severe OSA with recommendations to initiate continuous positive airway pressure (CPAP) machine therapy.

Conclusion: Most primary care providers do not routinely screen at-risk patients for OSA despite existing clinical practice guideline recommending early and accurate diagnosis of OSA for this population. The Stop -Bang screening tool can reliably predict the presence of moderate to severe OSA. Early identification of OSA risks in the primary care setting through routing screening is very imperative in order to minimize its effects on cardiovascular morbidity and mortality. The obtained results highlight the potentially high unmet need for screening and treatment of OSA in the primary care setting.