Hospital screening for obstructive sleep apnea in patients admitted to a rural, tertiary care academic hospital with heart failure

ABSTRACT

Background

Rural communities represent a vulnerable population that would significantly benefit from hospital-based OSA screening given these areas tend to have significant health-care disparities and poor health outcomes. Although inpatient screening has been studied at urban hospitals, no study to date has assessed this approach in rural populations.

Methods

This study utilized the Electronic Medical Record (EMR) to generate a list of potential candidates by employing inclusion/exclusion criteria as screening. Subjects identified were then approached and offered information regarding the study. Screening for OSA entailed a tiered approach utilizing the sleep apnea clinical score (SAC) and portable sleep testing. Individuals identified as high risk (SAC ≥ 15) for OSA underwent evaluation with a portable sleep testing system while hospitalized. All participants with an apnea-hypopnea index (AHI) ≥5 events/h confirmed by a sleep medicine physician were considered screen positive for OSA. If approved/available, subjects screening positive for OSA were provided with an auto-titrating continuous positive airway pressure (PAP). Patient characteristics were analyzed using descriptive statistics. Categorical data were described using contingency tables, including counts and percentages. Continuously scaled measures were summarized by median with range. This study was registered with ClinicalTrials.gov. Identifier: NCT03056443.

Results

Nine hundred and fifty-eight potential subjects were identified. The three most common reasons for exclusion included previous OSA diagnosis or exposure to PAP therapy (n = 357), advanced illness (n = 380), and declined participation by the individual (n = 68). The remaining 31 subjects underwent further evaluation for obstructive sleep apnea. Twenty-three subjects had a high sleep apnea clinic score. Per our study protocol, 13 subjects who screened positive for OSA were initiated on APAP therapy. Conclusion: Our study provides important insight into the burden of sleep-disordered breathing (SDB) and unique challenges of hospital-based OSA screening/treatment in a rural setting. Our study identified barriers to successful screening in a rural population that may be well addressed by adapting previous research in hospital sleep medicine.

KEYWORDS:

• Obstructive sleep apnea
• hospital screening for obstructive sleep apnea
• rural health
• hospital treatment obstructive sleep apnea

Acknowledgments

The authors would like to acknowledge Sijin Wen of West Virginia University (School of Public Health) for their help with statistics and data analysis. West Virginia Clinical and Translational Science Institute also provided help with research-coordinated support, data analysis, and statistics.

Declaration of interest

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Additional information

Funding

Funding has been provided by the U.S. Department of Health and Human Services, National Institutes of Health - NIH/NIGMS 5U54GM104942-04Dr. Sunil Sharma has received unrestricted research grants from ResMed Inc.Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.