Improving Screening for Obstructive Sleep Apnea in Patients with Nocturia

Objectives: To assess the efficacy of implementing a screening tool for obstructive sleep apnea (OSA) in patients with nocturia in a urogynecology clinic.

Methods: This is a quality improvement project implemented in December of 2022 at a urogynecology clinic at a safety net hospital. Patients who are seen for new consultation are routinely screened for nocturia. As part of this project, those patients who screened positive for nocturia, which was defined as awaking from sleep at least once to void, were subsequently screened for OSA utilizing the STOP-BANG questionnaire. Patients who scored a 4 or higher on the questionnaire were referred to sleep medicine for a polysomnography. Additionally, measures of nocturia and its impact on quality of life were obtained by two questions from the International Consultation on Incontinence Questionnaire Nocturia Quality of Life (ICIQ-Nqol).

Results: From December 13, 2022 until March 21, 2023 127 new patients were seen for consultation. 99 patients were noted to have nocturia and 49.5% were screened with the STOP-BANG questionnaire. Of those screened, 46.9% met criteria to be referred to sleep medicine for. As of March 21, 2023, 26.1% of patients who had been referred to sleep medicine had undergone a polysomnography. 50% of patients who had completed their polysomnography were diagnosed with at least moderate sleep apnea and were fitted with a continuous positive airway pressure (CPAP) machine. The remaining 50% of patients were diagnosed with mild OSA and received education regarding sleep hygiene. 43.5% of patients with nocturia and a positive screen for OSA by the STOP-BANG found their nocturia to be quite a bit to extremely bothersome and 52.2% found it difficult to get enough sleep most nights to every night.

Conclusions: Approximately 50% of patients with nocturia who were screened were found to be intermediate to high risk for moderate to severe OSA. Of those patients referred for polysomnography, 50% met criteria to receive a CPAP machine. Given the prevalence of nocturia and its relation to OSA, patients should be routinely screened for OSA. Additional assessments regarding limitations to implementation for screening need to be assessed for more effective screening.