Abstracts

Rationale: Obstructive sleep apnea (OSA) affects the lives of many people living with epilepsy. Patients with epilepsy and OSA are at risk for reduced cognitive functioning, reduced quality of life (QOL), and worsened seizure control. OSA can be difficult to detect based solely on a standard interview and neurologic examination. However, validated screening tools such as the STOP-BANG questionnaire (see Table 1) exist to help with detection. Given the potential of OSA treatment to help reduce seizure burden and improve QOL, we performed a quality improvement project in our epilepsy clinic. We evaluated OSA screening prior to the use of a standardized screening tool. We then implemented the STOP-BANG screening tool and evaluated for improvements in the rates of screening, detection, and sleep medicine referrals for patients with suspected OSA.Methods: The electronic medical records of all patients seen in our outpatient epilepsy clinic were screened for a period of 3 months prior to the intervention. We determined the number/percentage who were screened for OSA based on the history and physical alone and referred to sleep medicine. Following the initial screen, we implemented the STOP-BANG questionnaire for the subsequent 3 months. Physicians were encouraged to refer patients answering yes to >=3 questions to our outpatient sleep center for further evaluation. The number and percentage that were screened for OSA and referred to sleep medicine were subsequently calculated and compared to pre-intervention data.Results: A total of 664 patients were seen in our epilepsy clinic during the 3 months prior to the intervention. Only 22 patients (3.3%) had their sleeping habits explored and documented in the medical record. Only 11 patients (1.7%) were referred to sleep medicine. The records of 649 patients seen in our epilepsy clinic following the intervention were subsequently examined. Following implementation of the STOP-BANG questionnaire, the percentage of patients screened for OSA significantly increased to 41.8% (271/649, Chi-square Fisher’s Exact test 2-sided p<0.001). Of the 271 patients screened, 86 (31.7%) met criteria for elevated OSA risk. Forty eight patients were referred to sleep medicine. This represented 7.4% of all 649 patients, a significant improvement over the percentage referred prior to the intervention (Chi-square Fisher’s Exact test 2-sided p<0.001). Physicians tended to be more likely to refer when scores were >=5 (56%) than when scores were 3-4 (21/61, 34.4%), although this did not reach statistical significance (Chi-square Fisher’s Exact test 2-sided p=0.091).Conclusions: Almost one third of outpatients seen in our epilepsy clinic screened positive for elevated OSA risk. Such patients are easily missed when screening tools are not utilized, with less than 2% being referred to sleep medicine. However, the application of a simple screening tool resulted in an over four-fold improvement in the referral of at risk patients to sleep medicine.