Implementation of obstructive sleep apnea screening tools in hemodialysis centers for patients with end-stage renal disease

Background: Chronic Kidney Disease (CKD) is a devastating health crisis affecting approximately 37 million United States adults. Obstructive sleep apnea (OSA) is a commonly, undiagnosed comorbidity among CKD and End-Stage Renal Disease (ESRD) patients. The prevalence of OSA is reported to range from 45%-70% in ESRD patients, which is significantly higher than the general population at 3% -7%. Screening tools such as Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire (BQ) may assist in identifying patients at risk for OSA. Purpose: The purpose of this quality improvement project was to initiate the implementation of OSA screening tools in a north Flordia hemodialysis center to identify patients with ESRD at risk for OSA. Methods: This was a quality improvement project that used a pretest-posttest design to evaluate case managers’ (CM) knowledge of OSA and the implementation of the Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire (BQ) screening tools. A total of 15 CMs attended a brief OSA education session and completed a pre-post OSA knowledge survey prior to screening patients using the ESS and BQ screening tools. Results: The results (t = 11.75, p = 0.001) showed a statistically significant improvement in CM knowledge between the pre-post OSA education scores. The results also found that 47% of patients screened were at high risk for OSA, resulting in 8 patients referred for a sleep study. Implications: Providing education to the CM on OSA and establishing a protocol to screen patients can lead to early sleep study referrals and more timely treatment.