Nurse Practitioner-Led Obstructive Sleep Apnea Screening in Patients with an Implantable Cardiac Monitor, and Confirmed or Suspected Atrial Fibrillation

Background: Obstructive sleep apnea (OSA) has been linked to heart disease and vice versa. Millions of Americans suffer from this chronic sleep condition, and a great number of those affected are unaware they have it. According the American Sleep Apnea Association, 80% of patients who fall in the moderate to severe OSA category are undiagnosed. Evidence suggest that untreated OSA can lead to atrial fibrillation (AF), and other cardiovascular problems. These cardiovascular complications can increase the mortality and morbidity of patients who suffer from this sleep syndrome. Purpose of Project: The goal of the project was to provide OSA screening to patients with implantable cardiac monitors who were observed due to confirmed or suspected AF. The aim of this study was to identify the prevalence of those at high risk. Our overall purpose was to establish early screening protocols, that could potentially lead to early detection and treatment. The screening tool used was the STOP-BANG OSA screening tool due to its high sensitivity and specificity for detecting moderate to severe cases. Methods: Patients were screened for OSA risk by using the STOP-BANG tool. The phone screening calls were conducted between the hours of 9:00 am to 5:00pm on week days over a period of six months. The scores of 100 patients were obtained, and analyzed by using Microsoft Excel software. Evaluation/Results: The results showed that 63% of patients screened, scored as high risk for OSA. Of those who scored as high risk, 61.90% were males, 38.10% were female, 25.39% had previously been diagnosed with OSA, 4.76% were previously referred for sleep studies, and 69.84% have never been screened for OSA or referred for a sleep study. These findings suggested that the majority of patients at high risk for OSA are neither screened nor referred for sleep studies. The patients found to be at highest risk were males, older than 50y/o, obese, with a history of hypertension and syncope. Discussion: This project has the potential to provide information regarding the prevalence of OSA in patients who are diagnosed or are suspected to have AF. The prevalence of OSA in this patient population can give us knowledge regarding their health care needs. It can also help providers focus interventions that can potentially improve health care outcomes. Early screening can lead to early referral and treatment. This in turn may lead to decrease exacerbation of AF, and improved overall quality of life for patients who have coexisting AF and OSA