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.