Inpatient Screening for Obstructive Sleep Apnea Syndrome Using the Adjusted Neck Circumference Score

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Inpatient Screening for Obstructive Sleep Apnea
Syndrome Using the Adjusted Neck Circumference
Score Eldrige Pineda July 26, 2007
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Objectives

• Discuss purpose
• Discuss background
• Discuss methods
• Discuss current results
• Review Georgetown University Hospitals policy on
  inpatient screening for OSA
• Discuss possible future directions

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Purpose

• To identify all inpatients at risk for having OSA
  using the adjusted neck circumference score and
  evaluate whether screening will reduce
  in-hospital complications related to OSA

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Background

• 2 sentinel hospital events
• OSA associated with pulm HTN, MI, CVA, heart
  failure, dysrhythmias, and post-op complications

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Background

• Wisconsin Sleep Cohort Study reported 4 of men
  and 2 of women met the minimal criteria for OSA
• Young et al., NEJM, 1993 estimated the prevalence
  of OSA in 24 of men and 9 of women ages 30 to
  60

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Background

• Hiestand et al, Chest, 2006 suggested that 1 in 4
  American adults could benefit from evaluation of
  OSA based on the results of the National Sleep
  Foundation 2005 poll
• Gurubhagavatula et al, AJRCCM, 2004 assessed
  commercial drivers

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Background

• Flemons et al, AJRCCM, 1994 developed a sleep
  apnea clinical score model
• Flemons, NEJM, 2002 reported an adaptation of the
  model using the adjusted neck circumference where
  probability of OSA
• low
• intermediate 43 to 48cm
• high 48cm

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Background
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Methods

• Observational study
• Initiated in October 2006
• Nurse/Resp Therapy driven protocol using the
  adjusted neck circumference score
• If score 48, place purple ID band and placed on
  continuous pulse ox

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Results

• Total 883
• 642 males and 241 females, ave age 55.66 /-
  13.12
• 678 had scores 48 (76.8), ave score 50.99 /-
  5.1

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Results

• 727 of the 883 (82) had unknown hx of OSA
• M (534) F (193)
• Age 55.85/-13.19 54.47 /-13.7
• Score 51.55 /- 4.13 49.63 /- 5.22
• 48 457 (86) 125 (65)

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Future Direction

• Follow up patients if PSG done ?
• How will referral for PSG be handled ?
• Chart review of pulse ox trends ?
• Use another scoring tool ?