Obstructive Sleep Apnea Prevalent in the Hospital Setting

Jim Kling

June 15, 2010

June 15, 2010 (San Antonio, Texas) — Obstructive sleep apnea (OSA) is highly prevalent in hospitalized patients, many of whom receive narcotics and other drugs that could exacerbate the condition. The finding was presented as part of a study here at SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting.

Hospitalized patients frequently have comorbidities that have been linked to OSA, and the condition is often underrecognized, according to Dennis Auckley, MD, associate professor of medicine at Case Western Reserve University in Cleveland, Ohio, who presented the study.

To determine the extent of OSA in hospital patients, the researchers reviewed a sample of inpatients newly admitted to general medicine departments during a 4-month period at an urban academic center. Patients were assessed for OSA risk using the 4-question STOP (snoring, tiredness during daytime, observed apnea, and high blood pressure) assessment tool and the Berlin questionnaires and had to test positive on both to be considered at high risk for OSA. Data regarding the prescription of narcotics and benzodiazepines during their hospital stay were collected from electronic medical records.

Of 311 patients approached, 219 (70%) agreed to participate in the study. The mean ± SD age was 51.1 ± 14.4 years. Demographic data showed that 47.5% were male, 56.2% were white, 37.9% were African American, and 5.0% were Hispanic. Average body mass index was 32.3 kg/m2 (35.1 kg/m2 for the high-risk group vs 29.0 kg/m2 for the remainder).

Overall, 60.2% of patients tested positive on both the STOP and Berlin questionnaires. Of these, 81.8% had never been diagnosed as having OSA.

Dr. Auckley reported that 40.2% of the patients in the high-risk group had received orders for intravenous narcotics (39.4% actually received the drugs), 22.8% had been prescribed benzodiazepines (22.8% received the drugs), and 12.1% were prescribed both (12.1% received both). Despite these medications, none of the patients at high risk received orders for supplementary respiratory monitoring.

Patients with OSA may run into issues during the perioperative period, but they have not been looked at in the more general hospital setting, Dr. Auckley commented. The study was prompted in part by the experience of 1 patient at the facility who had OSA, was given drugs that had the potential to make it worse, and experienced an adverse event.

"We tried to get a handle on the magnitude of the potential problem in hospitalized patients," Dr. Auckley told Medscape Medical News,. "Sixty percent appeared to be at risk, so it looks like it could be a significant group. It kind of makes sense because patients admitted to the hospital often carry comorbidities. It's a sick population," he added.

The study was limited by a lack of objective testing. Still, "These patients [at high risk for OSA] are receiving drugs known to worsen sleep apnea, and this is happening in an unmonitored setting," he said.

The perioperative literature recommends regional analgesics or nonnarcotic medications or that physicians use pulse oximetry monitoring if narcotics are used, he added.

The results are important in light of the risk associated with pain medications. "We're much more liberal with pain medication because we got chastised for years and years for being scared of [prescribing] narcotics, so most doctors in a hospital setting are now very comfortable with intravenous morphine," Lisa Shives, MD, medical director of North Shore Sleep Medicine (Evanston, Illinois), told Medscape Medical News.

The results also suggest an opportunity to diagnose and sleep OSA, especially because it is linked to high blood pressure and stroke. "You have a captive population. It would be a great public health initiative to get all these hospitals screening for sleep apnea," said Dr. Shives.

The study did not receive commercial support. Dr. Auckley and Dr. Shives have disclosed no relevant financial relationships.

SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting: Abstract 0391. Presented June 7, 2010.

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