Hospital Sleep Apnea Screening Yields Undiagnosed Cases, Cuts Readmissions

A health system is using low-cost screening tools to identify hospitalized patients who may have also have obstructive sleep apnea.

A program launched at a West Virginia health system suggests that regular sleep-apnea screening for patients hospitalized for other disorders could help reduce readmission rates and result in faster diagnosis of serious sleep problems.

The program was launched at the West Virginia University Medicine by Sunil Sharma, MD, and colleagues. It specifically targets patients with congestive heart failure and chronic obstructive pulmonary disorder (COPD), since those conditions can be worsened by obstructive sleep apnea (OSA).

Once admitted to the hospital, patients with one or both conditions are given a screening questionnaire to determine whether there is a significant chance they might also be suffering from OSA. If the screening raises concern, that patient is monitored in the hospital using either high-resolution pulse oximetry (HRPO) or a device called ApneaLink, a sleep-testing device originally designed for in-home use.

In its first year, the program resulted in consultations with 1,000 patients, of whom 800 underwent monitoring with either HRPO or ApneaLink.

“Apart from obstructive sleep apnea, we can also identify central sleep apnea, Chynne Stokes breathing, nocturnal hypoxemia, obesity hypoventilation syndrome, insomnia, and restless leg syndrome due to comprehensive evaluation of these patients by the inpatient sleep service,” Sharma told Managed Healthcare Executive.

Nearly half of patients screened ended up being diagnosed with sleep apnea. In such cases, Sharma said, patients are given an appointment with a sleep study lab to confirm the diagnosis and take the next steps in terms of care.

The program is particularly beneficial in West Virginia, because the state has a shortage of sleep test labs, meaning patients sometimes have to wait weeks or months for an appointment. The tools used in the screening program—HRPO and ApneaLink—are both low-cost and non-invasive, resulting in a minimal burden on the patient.

From a hospital standpoint, Sharma said the program has been successful at reducing readmission rates, since treatment for OSA can prevent it from exacerbating associated conditions that might otherwise warrant a return visit to the hospital. He also noted that the program is beneficial in light of the Centers for Medicare and Medicaid Services’ new value-based care programs, which are designed to prevent readmissions by penalizing hospitals when patients with certain conditions return within 30 days. Previous research by Sharma showed that among patients hospitalized with severe COPD exacerbation, the risk of 30-day readmission was more than 6 times higher if the patient had moderate OSA compared to patients without OSA. If the patient had severe OSA, the risk or readmission within a month was 10 times higher than a patient without OSA.

Sharma said the health system is not yet being reimbursed for the screenings, though he said that could change in the future.

“Our return on investment is measured by data showing reduced hospital admissions (savings to the hospital) and better control of patient’s symptoms and comorbidities at home,” he said. “Based on the growing literature in this area, we are hopeful that in the near future it may be reimbursed.”

Sharma has extensively studied the issue of OSA and the benefits of screening. He said his experience demonstrates the benefits of a “health management” approach, as opposed to merely “chasing severe disease.”

“Identifying these disorders early and intervening will prevent significant complications and health deterioration down the road,” he said. “This template can be extended to other disease states and may lead to significant savings in healthcare dollars.”