Published on August 26, 2011

Uncovering Sleep Apnea

Pilot project screens Genesis hospital patients

The hospital will never be the ideal place to get a good night’s sleep.

However, a pilot project at Genesis Medical Center aims to bring hospital patients many future nights of good sleep by screening them for Obstructive Sleep Apnea.

The life-threatening sleep disorder causes brief interruptions of breathing during sleep, when soft tissues in the back of the throat relax and close off the airway. The pauses in breathing

can last 10-30 seconds or more and occur up to 400 times a night.

That combination of disturbed sleep and lack of oxygen leads to serious health complications -- from high blood pressure, heart disease and stroke to depression and memory problems.

Genesis’ pilot project screens patients to find out if they are at high risk for the sleep disorder that affects more than 18 million Americans, and frequently goes undiagnosed.

“Genesis wants our community to be healthy, alert and refreshed,” says Vicki Loving, Manager of Neurodiagnostics and the Genesis Sleep Disorders Center. “So many patients come into the hospital for other health conditions, yet their sleep apnea is never addressed. Sleep apnea can compound their cardiovascular and memory problems, increase length of stay and lead to complications.”

The screening

In the Genesis piIot, newly admitted patients (who have not already been diagnosed) are screened using a questionnaire to determine if they have “a high likelihood” of obstructive sleep apnea. Participating hospital units are Medical Telemetry at the Illini Campus and Pulmonary and Medical/Surgical at the West Central Park Campus.

Patients are asked about snoring, breathing cessation during sleep, fatigue and if they have ever nodded off or fallen asleep while driving. Height, weight, body mass index and high blood pressure are part of the questionnaire.

When results are inconclusive, nurses observe hospital patients while they sleep for signs of sleep apnea like snoring or pauses in breathing. Patients are informed if they are high risk, and a letter is sent to their primary care physician.

“We prefer not to test patients when they’re in the hospital. They’re on medications and not feeling well. They’re not having a typical night’s sleep,” Loving says.

“Once they’re out of the hospital, however, we hope they come to one of our five Genesis Sleep Disorders Center locations for a sleep clinic visit and a sleep test if recommended. If needed, we can fit them with a continuous positive airway pressure (CPAP) device.”

The screening will eventually be rolled out to all units at Genesis hospital campuses. The project is led by a team of Genesis nurses, sleep experts and biostatisticians.

Results

The results show the prevalence of obstructive sleep apnea among Genesis patients. The project launched Dec. 7, 2010 and the initial inpatient pilot study was for six months:

• Nearly 57 percent of inpatients on the three units were found to be at high risk for sleep apnea or had been diagnosed previously.

• As of Aug. 2, a total 714 patients were found to be at high risk for sleep apnea or had been diagnosed previously. Of those patients diagnosed before their hospital stay, 102 had been noncompliant with their sleep apnea treatment.

• Genesis employees and spouses in a wellness program to reduce their risk for metabolic syndrome also took the sleep screening. Of the 591 screened, 289 or 48.9 percent either had a previous diagnosis of sleep apnea or were at high risk.

The pilot developed after Loving gave a presentation on sleep apnea at Genesis University. She told how her elderly mother had been diagnosed with obstructive sleep apnea during a hospital stay.

“My mom was hypertensive and had five stents in her heart. She was underweight, had never smoked, and didn’t have a large neck -- a doctor would never guess her to be an apnea patient,” Loving says. “However, her grandkids would tease her about her snoring, and she slept better in a chair. Then she developed memory problems.

“She was diagnosed with really severe sleep apnea in the hospital. Had she been treated for sleep apnea earlier in life, perhaps she wouldn’t have had heart or memory problems. My own mother was a perfect example of why screening for sleep apnea in the hospital can be so beneficial.”

Stroke and heart disease

Genesis stroke coordinator Angie Overton knows how sleep apnea decreases oxygen levels, elevates blood pressure and increases circulatory problems that can cause stroke.

What she didn’t know, however, was that she herself had sleep apnea. That is, until she took the sleep apnea questionnaire and discovered she too was at high risk.

“I kept looking at the screening questionnaire and saying, ‘I do that. I do that. Maybe I have sleep apnea,’“ says Overton, RN, MSN, CNRN, who is on the pilot study team.

“As kids, we used to tease my parents about their snoring...not realizing it could signal a major health condition.”

Overton’s family physician referred her to the Genesis Sleep Disorders Center.

“Within an hour and a half, they stopped my sleep study, and I had qualified for a CPAP machine. My blood oxygen level was 75 percent...and that’s very low.”

That lack of oxygen is hard on the heart and brain.

• Stroke victims with a previous sleep apnea diagnosis are at a higher risk of death than those who do not have sleep apnea. Those with sleep apnea have a worse outcome during the first month after the stroke, a Mayo Clinic study found.

• Obstructive sleep apnea patients who used positive airway pressure for one month had a 32 percent increase in their Left Ventricular Ejection Fraction (a signal of the heart’s pumping power.) Their results completely reversed after one week without it, another study found.

Overton, a high-energy person, didn’t have the typical symptoms. “I wasn’t falling asleep at the wheel,” she says. “But I did find at 2 p.m. every day I needed a cup of coffee to pick me up.” On the first night at home using her CPAP machine, her husband doublechecked to make sure she was breathing; she slept so much quieter. “I have more energy; I lost 5 pounds almost immediately, and my triglycerides went into normal range,” Overton says.

Many highly regarded medical centers have begun screening patients for sleep apnea as part of their assessment for health risk factors, including those for heart disease, stroke and post-operative complications.

Patients at high risk for obstructive sleep apnea are encouraged to get a referral to the Genesis Sleep Disorders Center. The most successful treatment is continuous positive airway pressure, which uses mild air pressure to keep the airway open during sleep.

“Sleep apnea and snoring continue to be the brunt of jokes. People will say, ‘I snore, but everyone in my family snores,’ or ‘I’m tired because I’m getting older.’ The construction industry used to build snore rooms so families didn’t have to hear their loved one snore,” Loving concludes. “Now more people realize sleep apnea is a life-threatening medical condition that can lead to heart problems, stroke, memory loss and even car accidents.”