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A1492 - The Effect of Inpatient Screening and Treatment for Sleep Disordered Breathing on Re-Admissions in Minority Ethnic Population: A Health Disparity Project
Author Block: A. P. Quintos1, M. Rives-Sanchez1, A. Niroula1, L. Willes2, S. Sharma1; 1Pulmonary Critical Care, Allergy and Sleep, Albert Einstein Medical Center, Philadelphia, PA, United States, 2Willes Consulting Group, Inc., Encinitas, CA, United States.
RATIONALE Sleep disordered breathing (SDB) is a very common medical problem, albeit under-recognized. Inpatient screening increases the detection of SDB, and provides an opportunity for early initiation on positive airway pressure (PAP) therapy. The HosMED registry revealed a mortality benefit in compliant patients over a 3 year follow up. Our study aims to ascertain the burden of SDB in minority population, in terms of hospitalizations and emergency department (ED) visits. METHODS This is a combined retrospective and prospective study of minority ethnic inpatients with SDB from October 2016 to March 2017. Screening with STOP or STOP-BANG questionnaires were performed to identify those at high risk for SDB. High-risk patients were subsequently tested with either high resolution pulse oximetry for the oxygen desaturation index (ODI) or four-channel pneumogram, measuring the apnea hypopnea index (AHI). Patients with ODI>15 or AHI>5 subsequently had outpatient polysomnography. Those with polysomnography confirmed SDB and started on PAP therapy, were divided into compliant and non-compliant groups per CMS (Centers for Medicare and Medicaid Services) criteria. We looked at hospital admissions and ED visits for cardiopulmonary reasons 6 months prior to, and 6 months after screening and therapy. RESULTS A total of 722 patients were screened, and 687 patients (95%) were considered high risk for SDB. Out of these high-risk patients who had inpatient studies done, 207 (63%) tested positive, of which 43% had mild, 23% had moderate and 34% had severe disease. A total of 27 patients had polysomnographic confirmation and placed on PAP therapy, 10 of which were compliant and 17 were non-compliant with PAP therapy. The mean number of admissions per patient in the compliant group was 1.6 prior to therapy, and 0.3 after therapy, with a notable 1.3 decrease in mean number of admissions. In the non-compliant group, the mean number of admissions per patient was 1.6 prior to therapy, and 1.1 after therapy, with a decrease of 0.53 in mean number of admissions. The decrease in mean re-admissions between compliant and non-compliant patients was not statistically significant (p=0.14). CONCLUSION There is a notable trend of decrease in hospital admissions and ED visits pre- and post-treatment for SDB, in compliant versus non-compliant patients. Because of the small sample size, the difference between the two groups was not statistically significant. Further analysis on a larger cohort is recommended to detect the true impact of inpatient SDB screening and treatment on hospital re-admissions in minority population.