102 The efficacy of a pilot program for obstructive sleep apnea screening in pregnancy

Abstract

Pregnant patients with Obstructive Sleep Apnea (OSA) are at higher risk for eclampsia, gestational diabetes, cardiomyopathy, congestive heart failure and higher in-hospital mortality than pregnant patients without OSA. Unfortunately, OSA in pregnancy is under-diagnosed and opportunities for interventions are missed. A screening pilot program was developed at an obstetrics clinic in an urban teaching facility to improve diagnosis of OSA among pregnant patients. Every new obstetric patient was screened by a nurse for snoring/apneas, body mass index (BMI) > 35, essential hypertension, glucose disorders, neck size > 36 cm, and sleepiness. If a patient scored 2/6 or greater, a home sleep apnea test (HSAT) was ordered to diagnose OSA after discussion of risks and benefits with an obstetrician. In the 6 months prior to implementation of the screening program, zero patients were referred to the sleep medicine clinic. After the initiation of the screening program, 571 women were screened and 124 met criteria to be at high risk for OSA. The rate of tests ordered for patients who screened positive was 35%. Of the tests that were ordered 57% of patients performed the test. Out of the 26 patients who performed portable sleep testing, 16 were diagnosed with OSA with an apnea-hypopnea index (AHI) ≥ 5, which is 61% of those tested. Only 4 patients followed up in the sleep clinic after diagnosis, and only 3 patients met initial compliance with CPAP therapy as measured by percent usage over 30 days greater than 4 hours. A significant increase in screening for obstructive sleep apnea was achieved with implementation of screening protocol. High rate of diagnosis of OSA via HSAT does point to adequacy of six-question screening protocol. There were several patients who screened positive; however, few underwent testing for OSA, and even fewer still started CPAP and were compliant with therapy. This quality initiative program increased detection rates, however there is room for improvement in educating and maintaining patient compliance with therapy.