The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

IMPLEMENTATION OF A SLEEP APNEA SCREENING PROTOCOL IN AN INPATIENT POPULATION

CONTACT (NAME ONLY): Darius Rhodes-Zoroufy MD

Authors(All): Rhodes-Zoroufy MD, Darius; Pascualy MD, Ralph; Doyle, Paul; Malmgren PhD, Judith A. 2, 3  ; Repasky RRT, RPSGT, Debra - Presenter

Institutions (All):
1. Swedish Sleep Medicine Institute, Seattle, WA. USA
2. Department of Epidemiology, University of Washington, Seattle. WA. USA
3. HealthSTAT Consulting Inc. Seattle, WA. USA

 

Introduction: A higher prevalence of sleep apnea may be present in an inpatient population due to co-morbidities and anesthesia, putting patients at greater risk of poor outcome due to acute cardiovascular, pulmonary and neurologic complications. To address this issue a clinical pathway was implemented to identify, assess and treat patients with known or presumed sleep apnea. 

Methods: A new clinical pathway, PRAIS (Protocol for Recognition of Apnea in Sleep), was implemented in 2004 at a large tertiary care center. A three item nurse-administered questionnaire was considered positive triggering sleep medicine assessment, if at least one of the following were true: significant snoring, witnessed apnea in sleep, or prior CPAP use.  During the hospitalization if witnessed apnea occurred or clinical history suggested sleep apnea, sleep medicine assessment took place, which included overnight oximetry recording when appropriate.  Patients were excluded if their health status was inappropriate for testing or treatment

e.g. DNR orders present, sinus surgery, etc., they refused testing or treatment, or they were discharged or expired before assessment could be conducted.

Results: 969  adult inpatients were evaluated between January, 2004 and March, 2006.  Of 365 receiving oximetry testing 321 (87.9%) were positive for significant desaturation episodes. 355 (36.6%) had past sleep apnea and 546 (56.3%) had a new presumptive diagnosis of sleep apnea, 54 (9.9%) of whom had new positive airway pressure treatment initiated.  However, the subgroup from the last 6 months of data collection included 111 new presumptive sleep apnea diagnoses, 43 (38.7%) of whom had new PAP initiated. 

Conclusion: An inpatient sleep apnea screening protocol can be successfully implemented with significant identification and treatment of newly diagnosed sleep apnea patients in need of CPAP treatment.


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