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खुला एक्सेस

अमूर्त

Accelerated Diagnosis and Treatment of Sleep Apnea in Hospitalized Patients. Practice Improvement Method for Ensuring Follow up

Rose A Franco and Dheeraj Dhotre

Background: Sleep Apnea Syndrome is common and underdiagnosed in the hospitalized patient population. Protocols for evaluation of sleep apnea in the inpatient setting are not standardized.

Study question: Does requiring a sleep and breathing consultation when requesting a type 3 portable monitor to evaluate for sleep apnea syndrome in the inpatient setting lead to better follow up and continuous positive airway pressure device (CPAP) use than open access to this testing.

Methods: Retrospective chart review of patients who underwent a type 3 portable sleep study between 2008 to 2010 from a tertiary care, academic medical center. Midway through the period of review the process of ordering was changed to include mandatory pulmonary consultation. 105 patient records were analyzed for outcomes including diagnosis and ongoing care for sleep disordered breathing.

Results: The number of studies adequate for interpretation was not impacted by addition of a mandatory consult (87% vs. 92%), nor was the number of positive studies with an AHI >5 (80% vs. 73%). Follow up after undergoing a diagnostic type 3 study was significantly higher in the post intervention group (51% vs. 76%, P=0.04). Medical follow up as outpatient and CPAP initiation for those with a positive study was also significantly higher with the consultation requirement (55% vs. 84%, P=0.024).

Conclusion: In the hospitalized setting, a type 3 portable monitor for evaluation of sleep apnea when paired with a consultation from a sleep/pulmonary specialist can significant improve the likelihood outpatient follow up and improved likelihood of ongoing adherence for those who are initiated on CPAP. Large controlled multicenter studies are needed to determine if a protocol for identifying at risk hospitalized patients coupling type 3 testing with an experienced consultant in the evaluation of sleep disordered breathing translates to improved value based care.