Abstract
The purpose of this quality improvement (QI) project was to implement routine obstructive sleep apnea screening using the STOP-Bang questionnaire for adults presenting to a primary care clinic. Obstructive sleep apnea (OSA) is emerging as a significant health concern in the United States. Undiagnosed and unmanaged OSA is costly and has associated adverse health consequences. In the primary care setting, adults are not routinely screened for obstructive sleep apnea. Three nurse practitioners participated in the QI project. Adults age 19 years and older who presented to a family medicine (primary care) clinic in Omaha, Nebraska, for annual physical, preoperative clearance, or hypertension visit were included. Individuals were excluded if they were 18 years or younger, previously diagnosed with OSA, previously completed a sleep study in the past year, or presenting for an acute care visit. The STOP-Bang questionnaire was used to screen adults who met inclusion criteria. The nurse practitioners decided the intervention, which included no intervention, education, referral, or other. Forty-one individuals were screened for OSA during a 3-month timeframe. The average number of individuals screened per day was four. Of the individuals screened, 41.5% received referral or education for OSA. Four individuals were referred for a sleep study. At two months post-project implementation, one individual completed testing and was diagnosed with moderate OSA. Without routine screening, individuals at high-risk for obstructive sleep apnea may go years without diagnosis and management. Missed opportunities to screen for OSA may result in diagnosis and management delays. These delays can potentially leave individuals vulnerable to the morbidity and mortality associated with undiagnosed and, thus, unmanaged obstructive sleep apnea.