S2723 Obstructive Sleep Apnea Risk and Screening Gaps in Patients With Cirrhosis: A Primary Care Perspective

Introduction: Obstructive sleep apnea (OSA) is increasingly recognized as a comorbidity in patients with chronic liver disease, including cirrhosis. OSA contributes to systemic inflammation, cardiovascular disease, and impaired sleep quality. These factors may worsen cirrhosis-related morbidity. Despite these associations, OSA remains underdiagnosed in this population. Current guidelines do not specifically recommend routine screening for OSA in cirrhosis, and real-world screening practices remain poorly characterized. Methods: The resident-run VA primary care panel, which includes about 2,000 patients, was queried for a diagnosis of cirrhosis (SCT 19943007). Of 31 identified patients, 3 were excluded due to death, leaving 28 patients for analysis. Electronic medical records were reviewed to identify prior diagnoses of OSA, sleep study completion, and use of continuous positive airway pressure (CPAP). Patients were contacted by telephone to assess sleep-related symptoms and self-reported sleep quality. The STOP-BANG questionnaire, modified to exclude neck circumference, was used to evaluate OSA risk. Patients with intermediate or high STOP-BANG scores and symptoms concerning for OSA were offered referral to the sleep clinic. Results: Among 28 patients with cirrhosis, the mean age was 71.0 ± 8.1 years. A prior diagnosis of obstructive sleep apnea (OSA) was documented in 10 patients (35.7%). Eight patients (28.6%) were actively using continuous positive airway pressure (CPAP). One patient (3.6%) had deferred CPAP therapy, and another (3.6%) was referred for device refitting. Among the 18 patients (64.3%) without a known OSA diagnosis, 6 (21.4%) could not be reached. Of the 12 patients (42.9%) who responded, 5 (17.9%) reported sleep-related symptoms. Three (10.7%) were classified as high risk with STOP-BANG scores ≥5, and 2 (7.1%) were intermediate risk with scores of 3. Only one high-risk patient (3.6%) accepted referral. Both intermediate-risk patients declined further evaluation. Of the 7 patients (25.0%) who denied sleep symptoms, 3 (10.7%) had STOP-BANG scores ≥4 and declined referral. The final 3 (10.7%) had scores <3 and will be reassessed at future visits. Conclusion: OSA remains underrecognized and undertreated in cirrhosis, even when risk factors or symptoms are present. STOP-BANG screening identified several high-risk individuals, but referral uptake was limited. These findings support the need for structured screening and improved education regarding OSA in chronic liver disease.