Enhancing Obstructive Sleep Apnea Screening and Nocturia Treatment: A Quality Improvement Study

Importance Obstructive sleep apnea (OSA) is common but likely underdiagnosed in urogynecology patients with nocturia, and OSA treatment has the potential to improve nocturia symptoms. Objective The aim of the study was to assess the effect of implementing a universal screening protocol for OSA in a urogynecology clinic on screening rates, OSA prevalence among patients with nocturia, and symptom improvement following treatment. Study Design This was an observational quality improvement study at a urogynecology clinic at a safety-net hospital. Health care providers were asked to screen all new patients with nocturia using the STOP-BANG questionnaire. We assessed screening rates over an 18-month period and followed patients referred for sleep study to determine the percentage who completed evaluation, were identified as having OSA and, if necessary, prescribed treatment, as well as improvement in nocturia symptoms after treatment. Results Seventy-eight percent of eligible patients were screened, and screening rates increased substantially over the course of the study. Overall, 20.2% of patients screened positive and were referred for sleep study, and 80.6% of those were ultimately diagnosed with OSA. There were low levels of adherence to the recommended OSA treatment, but patients with OSA who were using the treatment reported better improvement in their symptoms. Conclusions Initiation of OSA screening in a urogynecology clinic is a significant and feasible way to address nocturia and has the potential to improve symptoms. Improving rates of OSA testing and adherence to OSA treatment will require a multidisciplinary approach, while systems-level changes are needed to address inequities and other barriers to accessing treatment.