Identification of Obstructive Sleep Apnea Symptoms Among Veterans in the Primary Care Setting

Untreated obstructive sleep apnea (OSA) has long-term cardiovascular and metabolic health implications, impacting quality of life and increasing health expenditures. Veterans have a higher prevalence rate of OSA attributed to an aging population and higher rates of comorbid conditions. The problem of under recognition of OSA symptoms partly relates to clinicians needing to elicit relevant symptoms routinely. At the same time, the lack of primary-care-based screening protocols contributes to the percentage of undiagnosed OSA. The purpose of this evidence-based project was to implement routine screening to identify OSA risk among veterans in primary care settings in South Carolina. The method included using the Stop-Bang questionnaire (SBQ), a validated screening tool to measure OSA risk, to enhance identifying OSA symptoms among a convenience sample of veterans. Male and female veterans without a previous diagnosis of OSA or cognitive impairment were eligible for participation. For veterans completing OSA screening, analyses included descriptive statistics, frequencies, and percentages for observations on each SBQ item. Total SBQ scores were interpreted as low, intermediate, or high risk for OSA. An SBQ score of greater than three (intermediate to high risk) prompted a recommendation for further diagnostic testing. The frequency of OSA risk by hypertension, obesity, and gender and the percentage of recommended referrals by risk level were reported. Implications for practice include mitigating the adverse consequences of undiagnosed OSA and increasing diagnostic referral through routine primary care-based OSA screening.