1124 Enhancing Screening for Obstructive Sleep Apnea in Patients with Post Traumatic Stress Disorder: A Quality Improvement Initiative

Abstract Introduction The bidirectional relationship between Obstructive Sleep Apnea (OSA) and Post Traumatic Stress Disorder (PTSD) is well documented. Untreated OSA can reduce patient response to evidence-based PTSD therapies. Evidence supports screening PTSD patients for OSA but this is not routinely performed at our institution. This Quality Improvement (QI) project sought to increase the referral rate of patients with PTSD from behavioral health (BH) to sleep medicine for OSA evaluation. Methods Retrospective review of referrals received by our academic sleep disorders center in July 2025 was conducted to establish baseline rate of referrals from BH for suspected OSA in patients with PTSD. For the initial intervention we reviewed literature linking these two disorders during a combined conference with BH providers. For the subsequent intervention we provided the STOP-Bang screening tool to the BH clinic for use in group therapy for patients with sleep complaints and ad-hoc use with patients diagnosed with PTSD. Additionally, we clarified the referral process. The primary outcome measure compared rate of referrals from the target clinic in 3-week intervals following each intervention cycle. Results During the baseline assessment period, BH referred 1 patient (female, active-duty) for OSA evaluation and she had PTSD. After the initial intervention we received 7 (n=2 female, 7 active-duty, 0 with PTSD) referrals from BH requesting OSA evaluation, a 600% increase from baseline. Following the second intervention we received 9 (n=3 female, 8 active-duty, 1 with PTSD) referrals, a 28.6% increase in referral from the first intervention. The number of PTSD patients referred remained unchanged. Conclusion Though a bi-directional link between PTSD and OSA is well established, there is a gap in the clinical appreciation of this relationship. We demonstrated during this ongoing QI project that simple interventions aimed at collaborating with BH can influence referral patterns. Our interventions reinforced use of the STOP-Bang screening tool and promoted referrals to our clinic from BH. Additional work is needed to ensure patients with PTSD are adequately screened and referred. Future planned interventions include flagging charts of patients with PTSD for screening and creating autotext in the electronic medical record to automate the referral process. Support (if any)