0503 Standardizing Obstructive Sleep Apnea Screening in Primary Care Clinic: Effects of implementing STOP-BANG

Abstract

Introduction: Obstructive sleep apnea (OSA) occurs in 5% of the general U.S. population and is associated with many medical co-morbidities. Primary care physicians (PCP) do not use standardized OSA screening tools, but depend largely on body habitus and presence of OSA-associated symptoms as "triggers" for referrals, leaving many patients un-referred, undiagnosed, and untreated. OSA screening tools are validated in populations undergoing surgery or whom pulmonary or sleep medicine is already seeing. This study evaluates the OSA screening impact in a resident-run PCP clinic after the STOP-BANG questionnaire implementation. Method(s): Internal medicine residents at the Drexel University Internal Medicine Clinic voluntarily completed an initial resident survey to assess top patient qualities perceived important for sleep medicine referrals. It included both objective (central obesity, large neck girth; presence of resistant hypertension, cardiovascular disease, and type II diabetes) and subjective (daytime somnolence, excessive fatigue, snoring, apneic events) factors. Then, for 4-weeks, residents completed the paper form of the STOP-BANG questionnaire with each patient encounter. Finally, a retrospective chart analysis of patients with completed questionnaires was conducted to determine what percentage had been referred to sleep medicine prior to this study. Result(s): All residents perceived central obesity and large neck girth to be important factors leading to sleep medicine referrals with presence of co-morbidities being least impactful. Of the 296 STOP-BANG questionnaires completed, 53 scored high-risk, 114 moderate-risk, and 129 low-risk for OSA. Prior sleep studies were present for 16 pts (30%) scoring high-risk, of which 44% had severe OSA and 31% had moderate OSA, and 15 pts (13%) scoring intermediate- risk, of which 13% had severe OSA and 33% had moderate OSA. Therefore, 70% and 77% of pts scoring high-risk and intermediate- risk, respectively, were un-referred to sleep medicine at start of this study. Conclusion(s): More studies are needed to identify and validate appropriate OSA screening tools for primary care setting. This study is the first to use the STOP-BANG as such a tool and successfully revealed significant under-screening and under-referral of potential OSA patients in our PCP clinic.