0382 Optimizing Obstructive Sleep Apnea Screening and Education in Underserved Community

Abstract

Abstract Introduction Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. There are many conditions associated with OSA, including obesity hypoventilation syndrome, congestive heart failure, atrial fibrillation, pulmonary hypertension and pulmonary diseases. Majority of patients endorse daytime sleepiness, but family often report snoring and apneas. There are multiple screening tools, including the STOP-BANG. Scores 5 or above are high risk for OSA. Untreated OSA worsens comorbidities and increases risk of myocardial infarction and stroke. We provided physicians with this screening tool to help risk stratify, thus providing better patient education and treatment. Methods Physicians educated on OSA, STOP-BANG and documentation in didactic sessions. Patients ages 18 and older provided with questionnaire. Physicians measured neck circumference and BMI. Questionnaire reviewed with patient and education given. If high risk, sleep medicine referral recommended. Physicians documented in charts about discussion, risk category and referral status. Results Total of 407 patients completed the questionnaire, but 67 patients were excluded for no neck circumference. Remaining 340 patients stratified by STOP-BANG scores: 128 Low, 142 Intermediate, 70 High Risk. From High Risk category, 20 patients referred to Sleep Medicine. Only 18 charts from the 50 not referred explained why, which included patient declining, already on CPAP, referral already in, and because outpatient sleep study was ordered instead. Data stratified for age, gender, BMI and neck circumference. Age range from the 340 total was 19-87-years-old. From High Risk, 39 were male and 31 female. BMI range for total was 17-61, while High Risk was 22-61. Neck circumference range for total was 12-21 inches, while High Risk was 12.5-17.5 inches. Conclusion The goal was not only to provide a validated screening tool, but also provide better OSA education for physicians and patients. Results indicate many patients were intermediate or high risk. Majority of patients had multiple comorbidities, including obesity, hypertension and diabetes. This study highlights the prevalence of OSA in an inner-city primary care clinic and challenges involved in screening all at risk patients. Further investigations could include the effect of more education, continued screening and effect of lifestyle changes in this vulnerable population. Support (If Any)