While one out of every four Americans is estimated to suffer from obstructive sleep apnea (OSA), the prevalence of OSA in medical inpatients may be even higher. OSA is associated with many chronic medical conditions, such as cardiovascular and cerebrovascular disease, that are also prevalent in medical inpatients. Yet, the prevalence of undiagnosed in‐hospital OSA is not known. We aimed to assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among inpatients and to assess whether OSA risk is associated with in‐hospital sleep quantity and quality.
Hospitalized medical adult patients age 50 years and over without a self‐reported or documented diagnosis of a sleep disorder were enrolled from a single institution. The Berlin questionnaire, a validated nine‐item questionnaire that assesses snoring, sleepiness, and hypertension, was used to assess prevalence of undiagnosed OSA amongst inpatients. Sleep duration and efficiency (% time spent sleeping of time in bed) were measured via wrist actigraphy. We surveyed a convenience sample of internal medicine residents attending a routine educational conference about their knowledge and practices with respect to screening inpatients for OSA.
Four hundred and twenty‐five patients were enrolled (mean age, 65 years; 57% female; 72% African American). Two out of every five inpatients (39.5%, n=168) were found to be at high risk for OSA. Mean in‐hospital sleep duration was roughly 5 hours (313 minutes, SD=146) and mean sleep efficiency was below normal at 70% (95% CI 67.6‐71.6%). Using random effects linear regression models controlling for subject, those patients who screened at high risk for OSA obtained approximately forty minutes less sleep per hospital night (‐39.6 min [‐66.5,‐12.8], p=0.004) and had 5.5% lower sleep efficiency per hospital night as measured by actigraphy (‐5.5% [‐9.96, ‐1.05], p=0.015).). Both findings remained significant after controlling for African American race, sex, and age quartiles. In a convenience sample of internal medicine residents (n=26), although 50% reported that it was their responsibility to screen inpatients for sleep disorders, only 19% reported knowing how to screen patients for sleep disorders. Furthermore, no resident reported routinely screening inpatients for sleep disorders. No residents were satisfied with the training they received on sleep disorders.
Two out of every five inpatients screened at high risk for OSA. Hospitalized patients at high risk for OSA had lower in‐hospital sleep duration and worse sleep quality. It appears that inpatient physicians are not adequately trained in and do not routinely screen for sleep disorders. Given the potentially high prevalence of undiagnosed OSA on a medical ward, hospitalization may represent a missed opportunity for hospital staff to screen patients for OSA and facilitate referral and treatment, which can improve overall health of medical ward patients.
To cite this abstract:Shear T, Balachandran D, Mokhlesi D, Knutson K, Spampinato L, Meltzer D, Cauter D, Arora V. The “Sleeping Giant”: Risk of Obstructive Sleep Apnea in Hospitalized Medical Patients. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 137. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/the-sleeping-giant-risk-of-obstructive-sleep-apnea-in-hospitalized-medical-patients/. Accessed December 7, 2019.