0496 Screen to Treat Comorbid Obstructive Sleep Apnea Among Hospitalized Patients Before Discharge

Significant evidence has shown strong connections between obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD) and heart disease. Hospitalized patients with COPD exacerbations or heart failure (HF) have high OSA risks, low OSA diagnosis, and high re-hospitalization rates. A single-site feasibility study was designed to prospectively evaluate logistics of screening and testing for OSA among COPD and HF before hospital discharge. STOP-Bang and Home Sleep Apnea Testing (HSAT) were used to evaluate patients’ OSA risks and diagnosis. Triaged patients’ diagnosis, response to automatic Positive Airway Pressure (APAP) therapy, compliance, and care utilization data were analyzed. Results: In 6 months, 36 hospitalized patients were enrolled based on hospitalists’ evaluation, with a mean STOP-Bang score of 5.4 and 93.8% scoring ≥4. Patients’ mean age was 71.8 years, 44.4% were male and 91.7% had Medicare. 41.7% had type 2 diabetes, 86.1% were hypertensive and 30.1% had uncontrolled hypertension. Bedside HSAT was offered to all 36, with 31 (86.1%) successfully completed, 26 (83.9% of completed HSAT) diagnosed with co-morbid OSA (AHI mean =37.7), and 13 severe OSA. Of the 26, 69.2% were HF only, 19.2% COPD only while 11.5% had both. APAP was offered to all 26, with 15 (57.7%) successfully set up before discharge. APAP compliance rose from 34.5% mean rate of ≥4 hr/night within 30 days, to 37.3% for days 31-60, with 6 patients quitting. Of all 36, one HF readmission within 30-day and 27 all-cause emergency room visits were observed over a 90-day follow-up. The readmitted patients showed the poorest compliance. 4 deaths were observed, of which 2 failed HSAT and 1 showed poor compliance. Conclusion: OSA co-morbidity is under-diagnosed and under-treated among hospitalized HF/COPD patients, who were also at high risk of having other chronic conditions including uncontrolled hypertension. OSA can be effectively screened and diagnosed using a questionnaire and HSAT combined modality during a hospital stay. Upfront PAP therapy implementation rates and compliance over the follow-up timeline were low. A low cause-specific readmission rate was observed.