Protocolized sleep apnea screening among pregnant patients

SESSION TITLE: Sleep and Health Determinants SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Obstructive sleep apnea (OSA) is an under-recognized condition during pregnancy. Applications of sleep screening have been able to assess risk but little is known regarding incidence of medical emergency team activation (META) among pregnant patients. A quality and safety initiative was introduced at Atrium Health Wake Forest Baptist using the validated DoISnorePreg questionnaire among pregnant patients. All pregnant patients admitted were screened for OSA and safety measures were implemented based on risk assessment. We describe our safety interventions following OSA risk assessment by DoISnorePreg among admitted pregnant patients. METHODS: From 2021 to 2023 all hospitalized pregnant patients were screened for OSA using DoISnorePreg. Patient’s risk for sleep apnea was based on number of positive responses on the DoISnorePreg questionnaire: Low Risk (< 4), At Risk (4-5), and High Risk (≥6). Low Risk patients received usual care without additional monitoring. At Risk patients were provided an OSA risk wrist band, electronic reminder on EMR stating “At Risk for OSA”, and continuously monitored for heart rate, saturations, and blood pressure. High Risk pregnant patients received the same monitoring protocol and providers were alerted by EMR messaging to High Risk status with recommendations for Auto pap and inpatient sleep consultations. Analysis of screening performance and outcomes of LOS and META: code blue, code stroke, rapid response, and intubation. RESULTS: Among 9581 pregnant patients, 71% (6844) completed screening. Patients had a median age of 29 in whom 49% white. 93% (6392) were Low Risk, 5% (372) At Risk, and 1% (80) High Risk for OSA. Median LOS statistically differed across all risk groups 2.18, 2.74 and 2.91 days, respectively. Incidence of META (35 rapid response and 3 code strokes) was 0.55% (35), 0.53% (2), and 1.25% (1) among “Low Risk”, “At Risk”, and “High Risk” respectively. CONCLUSIONS: Sleep apnea screening and implementation of a sleep apnea safety protocol among pregnant patients can be achieved with fidelity. When applied in a general population of pregnant patients, patients at high risk for OSA by DoISnorePreg were found to have an association with increased LOS and increased percentage of META. The known clinical implications for untreated OSA are considerable and risk assessment with safety measures is essential. Risk stratification of pregnant patients using DoISnorePreg not only predicts OSA but also discriminates relevant clinical outcomes that aid clinicians in potentially mitigating adverse events. CLINICAL IMPLICATIONS: The results of a self-administered DoISnorePreg questionnaire screening, and protocolized safety measures, including patient and EMR identifiers and physician orders among pregnant patients, provides a simple and effective method in identifying pregnant patients at risk of OSA and META. DISCLOSURES: No relevant relationships by David Carter No disclosure on file for Laura Dean No relevant relationships by Dan Forest No disclosure on file for Edward Haponik No relevant relationships by Abigail Koch No relevant relationships by Melissa Kozakiewicz No relevant relationships by Andrew Namen No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Stephen Peters, value=Consulting fee Removed 04/08/2023 by Stephen Peters, source=Web Response No relevant relationships by Jonathan Prest No relevant relationships by Amit Saha No relevant relationships by Adam Schertz No relevant relationships by Kristin Sheehan No relevant relationships by Samantha Shirk No relevant relationships by Kang Rui Xiang